1
|
Tachino J, Togami Y, Matsumoto H, Matsubara T, Seno S, Ogura H, Oda J. Plasma Proteomics Profile-Based Comparison of Torso Versus Brain Injury: A Prospective Cohort Study. J Trauma Acute Care Surg 2024:01586154-990000000-00698. [PMID: 38595266 DOI: 10.1097/ta.0000000000004356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Trauma-related deaths and post-traumatic sequelae are a global health concern, necessitating a deeper understanding of the pathophysiology to advance trauma therapy. Proteomics offers insights into identifying and analyzing plasma proteins associated with trauma and inflammatory conditions; however, current proteomic methods have limitations in accurately measuring low-abundance plasma proteins. This study compared plasma proteomics profiles of patients from different acute trauma subgroups to identify new therapeutic targets and devise better strategies for personalized medicine. METHODS This prospective observational single-center cohort study was conducted between August 2020 and September 2021 in the intensive care unit of Osaka University Hospital in Japan. Enrolling 59 consecutive patients with blunt trauma, we meticulously analyzed plasma proteomics profiles in participants with torso or head trauma, comparing them with those of controls (mild trauma). Using the Olink Explore 3072® instrument, we identified five endotypes (α-ε) via unsupervised hierarchical clustering. RESULTS The median time from injury to blood collection was 47 minutes [interquartile range: 36-64 minutes]. The torso trauma subgroup exhibited 26 unique proteins with significantly altered expression, while the head trauma subgroup showed 68 unique proteins with no overlap between the two. The identified endotypes included α (torso trauma, n = 8), β (young patients with brain injury, n = 5), γ (severe brain injury post-surgery, n = 8), δ (torso or brain trauma with mild hyperfibrinolysis, n = 18), and ε (minor trauma, n = 20). Patients with torso trauma showed changes in blood pressure, smooth muscle adaptation, hypermetabolism, and hypoxemia. Patients with traumatic brain injury had dysregulated blood coagulation and altered nerves regeneration and differentiation. CONCLUSIONS This study identified unique plasma protein expression patterns in patients with torso trauma and traumatic brain injury, helping categorize five distinct endotypes. Our findings may offer new insights for clinicians, highlighting potential strategies for personalized medicine and improved trauma-related care. LEVEL OF EVIDENCE Prospective Cohort Study, Level III.
Collapse
Affiliation(s)
- Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita City, Osaka, Japan
| | - Yuki Togami
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita City, Osaka, Japan
| | - Hisatake Matsumoto
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita City, Osaka, Japan
| | - Tsunehiro Matsubara
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita City, Osaka, Japan
| | - Shigeto Seno
- Department of Bioinformatic Engineering, Graduate School of Information Science and Technology, Osaka University, 1-5 Yamada-oka, Suita City, Osaka, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita City, Osaka, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita City, Osaka, Japan
| |
Collapse
|
2
|
Watanabe Y, Nakamura I, Ishii Y, Oda J. Pasteurella multocida Bacteremia Caused by Household Cat Bites. Intern Med 2024:3576-24. [PMID: 38599860 DOI: 10.2169/internalmedicine.3576-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Affiliation(s)
- Yusuke Watanabe
- Department of Infection Prevention and Control, Tokyo Medical University Hospital, Japan
| | - Itaru Nakamura
- Department of Infection Prevention and Control, Tokyo Medical University Hospital, Japan
| | - Yuri Ishii
- Department of Emergency and Critical Care Medicine, Tokyo Medical University Hospital, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Japan
| |
Collapse
|
3
|
Mitsuyama Y, Matsumoto H, Togami Y, Oda S, Onishi S, Yoshimura J, Murtatsu A, Ito H, Ogura H, Okuzaki D, Oda J. T cell dysfunction in elderly ARDS patients based on miRNA and mRNA integration analysis. Front Immunol 2024; 15:1368446. [PMID: 38571958 PMCID: PMC10987699 DOI: 10.3389/fimmu.2024.1368446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/07/2024] [Indexed: 04/05/2024] Open
Abstract
Background Acute respiratory distress syndrome (ARDS) is respiratory failure that commonly occurs in critically ill patients, and the molecular mechanisms underlying its pathogenesis and severity are poorly understood. We evaluated mRNA and miRNA in patients with ARDS and elucidated the pathogenesis of ARDS after performing mRNA and miRNA integration analysis. Methods In this single-center, prospective, observational clinical study of patients with ARDS, peripheral blood of each patient was collected within 24 hours of admission. Sequencing of mRNA and miRNA was performed using whole blood from the ARDS patients and healthy donors. Results Thirty-four ARDS patients were compared with 15 healthy donors. Compared with the healthy donors, 1233 mRNAs and 6 miRNAs were upregulated and 1580 mRNAs and 13 miRNAs were downregulated in the ARDS patients. For both mRNA and miRNA-targeted mRNA, canonical pathway analysis showed that programmed death-1 (PD-1) and programmed cell death ligand 1 (PD-L1) cancer immunotherapy pathway was most activated and the Th2 pathway was most suppressed. For mRNA, the Th1 pathway was most suppressed. miR-149-3p and several miRNAs were identified as upstream regulators. Conclusion miRNAs regulated the PD-1 and PD-L1 cancer immunotherapy pathway and Th2 pathway through miRNA interference action of mRNA. Integrated analysis of mRNAs and miRNAs showed that T cells were dysfunctional in ARDS patients.
Collapse
Affiliation(s)
- Yumi Mitsuyama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hisatake Matsumoto
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuki Togami
- Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Sayaka Oda
- Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Shinya Onishi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jumpei Yoshimura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Arisa Murtatsu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Ito
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Okuzaki
- Genome Information Research Center, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
4
|
Tachino J, Seno S, Matsumoto H, Kitamura T, Hirayama A, Nakao S, Katayama Y, Ogura H, Oda J. Association between tranexamic acid administration and mortality based on the trauma phenotype: a retrospective analysis of a nationwide trauma registry in Japan. Crit Care 2024; 28:89. [PMID: 38504320 PMCID: PMC10953216 DOI: 10.1186/s13054-024-04871-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND In trauma systems, criteria for individualised and optimised administration of tranexamic acid (TXA), an antifibrinolytic, are yet to be established. This study used nationwide cohort data from Japan to evaluate the association between TXA and in-hospital mortality among all patients with blunt trauma based on clinical phenotypes (trauma phenotypes). METHODS A retrospective analysis was conducted using data from the Japan Trauma Data Bank (JTDB) spanning 2019 to 2021. RESULTS Of 80,463 patients with trauma registered in the JTDB, 53,703 met the inclusion criteria, and 8046 (15.0%) received TXA treatment. The patients were categorised into eight trauma phenotypes. After adjusting with inverse probability treatment weighting, in-hospital mortality of the following trauma phenotypes significantly reduced with TXA administration: trauma phenotype 1 (odds ratio [OR] 0.68 [95% confidence interval [CI] 0.57-0.81]), trauma phenotype 2 (OR 0.73 [0.66-0.81]), trauma phenotype 6 (OR 0.52 [0.39-0.70]), and trauma phenotype 8 (OR 0.67 [0.60-0.75]). Conversely, trauma phenotypes 3 (OR 2.62 [1.98-3.47]) and 4 (OR 1.39 [1.11-1.74]) exhibited a significant increase in in-hospital mortality. CONCLUSIONS This is the first study to evaluate the association between TXA administration and survival outcomes based on clinical phenotypes. We found an association between trauma phenotypes and in-hospital mortality, indicating that treatment with TXA could potentially influence this relationship. Further studies are needed to assess the usefulness of these phenotypes.
Collapse
Affiliation(s)
- Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita City, Osaka, Japan.
| | - Shigeto Seno
- Department of Bioinformatic Engineering, Graduate School of Information Science and Technology, Osaka University, 1-5 Yamada-oka, Suita City, Osaka, Japan
| | - Hisatake Matsumoto
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita City, Osaka, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita City, Osaka, Japan
| | - Atsushi Hirayama
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita City, Osaka, Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita City, Osaka, Japan
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita City, Osaka, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita City, Osaka, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita City, Osaka, Japan
| |
Collapse
|
5
|
Fujimoto R, Oda S, Matsumoto H, Nakao S, Shimizu K, Okuzaki D, Oda J. Longitudinal whole blood transcriptome analysis of a septic shock patient with secondary hemophagocytic syndrome. QJM 2024:hcae043. [PMID: 38460187 DOI: 10.1093/qjmed/hcae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Indexed: 03/11/2024] Open
Affiliation(s)
- Rio Fujimoto
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - Sayaka Oda
- Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Hisatake Matsumoto
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Center for Infectious Disease Education and Research, Osaka University, Osaka, Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kentaro Shimizu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Okuzaki
- Genome Information Research Center, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
- Center for Infectious Disease Education and Research, Osaka University, Osaka, Japan
- Laboratory of Human Immunology (Single Cell Genomics), WPI Immunology Research Center, Osaka University, Osaka, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
6
|
Katayama Y, Tanaka K, Domi H, Masui J, Nakao S, Tachino J, Hirose T, Kitamura T, Oda J, Matsuoka T. Outcome of emergency patients transported by ambulance during the COVID-19 pandemic in Osaka Prefecture, Japan: a population-based descriptive study. Front Public Health 2024; 11:1322236. [PMID: 38274542 PMCID: PMC10808805 DOI: 10.3389/fpubh.2023.1322236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Background The novel corona virus (COVID-19) pandemic occurred worldwide. Although an excessive burden was placed on emergency medical institutions treating urgent and severe patients, its impact on patient outcome remains unknown. This study aimed to assess the impact of the COVID-19 pandemic in 2021 on the emergency medical services (EMS) system and patient outcomes in Osaka Prefecture, Japan. Methods This was a retrospective descriptive study with a study period from January 1, 2019 to December 31, 2021. We included patients who were transported by ambulance and had cleaned data that was recorded in the ORION system. The study endpoints were the number of patients transported by ambulance and the number of deaths among these patients in each month. To assess the impact of the COVID-19 pandemic on the EMS system, the incidence rate ratio (IRR) and 95% confidence interval (CI) were calculated using 2019 as the reference year. Mortalities were evaluated based on deaths in the emergency department and deaths at 21 days after hospitalization. Results The numbers of patients transported by ambulance were 500,194 in 2019, 443,321 in 2020 (IRR: 0.88, 95% CI: 0.87-0.88), and 448,054 in 2021 (IRR: 0.90, 95% CI: 0.89-0.90). In 2019, the number of patients transported by ambulance and who died in the emergency departments was 4,980, compared to 5,485 in 2020 (IRR: 1.10, 95% CI; 1.06-1.44) and 5,925 in 2021 (IRR: 1.19, 95% CI: 1.15-1.24). In 2019, the number of patients who died within 21 days after hospitalization was 11,931, compared to 11,913 in 2020 (IRR; 1.00, 95% CI; 0.98-1.03) and 13,376 in 2021 (IRR; 1.12, 95% CI; 1.09-1.15). Conclusion The COVID-19 pandemic decreased the number of ambulance requests and worsened mortality of patients transported by ambulance in Osaka Prefecture during 2021.
Collapse
Affiliation(s)
- Yusuke Katayama
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenta Tanaka
- Department of Social and Environmental Medicine, Division of Environmental Medicine and Population Sciences, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hisaya Domi
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Osaka Prefectural Government, Osaka, Japan
| | - Jun Masui
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Department of Emergency Medicine, Tane General Hospital, Osaka, Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuhisa Kitamura
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Department of Social and Environmental Medicine, Division of Environmental Medicine and Population Sciences, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuya Matsuoka
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Rinku General Medical Center, Izumisano, Japan
| |
Collapse
|
7
|
Kang S, Onishi S, Ling Z, Inoue H, Zhang Y, Chang H, Zhao H, Wang T, Okuzaki D, Matsuura H, Takamatsu H, Oda J, Kishimoto T. Gp130-HIF1α axis-induced vascular damage is prevented by the short-term inhibition of IL-6 receptor signaling. Proc Natl Acad Sci U S A 2024; 121:e2315898120. [PMID: 38165930 PMCID: PMC10786312 DOI: 10.1073/pnas.2315898120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/22/2023] [Indexed: 01/04/2024] Open
Abstract
Protection against endothelial damage is recognized as a frontline approach to preventing the progression of cytokine release syndrome (CRS). Accumulating evidence has demonstrated that interleukin-6 (IL-6) promotes vascular endothelial damage during CRS, although the molecular mechanisms remain to be fully elucidated. Targeting IL-6 receptor signaling delays CRS progression; however, current options are limited by persistent inhibition of the immune system. Here, we show that endothelial IL-6 trans-signaling promoted vascular damage and inflammatory responses via hypoxia-inducible factor-1α (HIF1α)-induced glycolysis. Using pharmacological inhibitors targeting HIF1α activity or mice with the genetic ablation of gp130 in the endothelium, we found that inhibition of IL-6R (IL-6 receptor)-HIF1α signaling in endothelial cells protected against vascular injury caused by septic damage and provided survival benefit in a mouse model of sepsis. In addition, we developed a short half-life anti-IL-6R antibody (silent anti-IL-6R antibody) and found that it was highly effective at augmenting survival for sepsis and severe burn by strengthening the endothelial glycocalyx and reducing cytokine storm, and vascular leakage. Together, our data advance the role of endothelial IL-6 trans-signaling in the progression of CRS and indicate a potential therapeutic approach for burns and sepsis.
Collapse
Affiliation(s)
- Sujin Kang
- Department of Immune Regulation, Immunology Frontier Research Center, Osaka University, Suita, Osaka565-0871, Japan
- Department of Immune Regulation, Center for Infectious Disease Education and Research, Osaka University, Suita, Osaka565-0871, Japan
| | - Shinya Onishi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka565-0871, Japan
| | - Zhenzhen Ling
- Department of Immune Regulation, Immunology Frontier Research Center, Osaka University, Suita, Osaka565-0871, Japan
| | - Hitomi Inoue
- Department of Immune Regulation, Immunology Frontier Research Center, Osaka University, Suita, Osaka565-0871, Japan
| | - Yingying Zhang
- Department of Immune Regulation, Immunology Frontier Research Center, Osaka University, Suita, Osaka565-0871, Japan
| | - Hao Chang
- Department of Immune Regulation, Immunology Frontier Research Center, Osaka University, Suita, Osaka565-0871, Japan
| | - Hui Zhao
- Department of Immune Regulation, Immunology Frontier Research Center, Osaka University, Suita, Osaka565-0871, Japan
| | - Tong Wang
- Department of Immune Regulation, Immunology Frontier Research Center, Osaka University, Suita, Osaka565-0871, Japan
| | - Daisuke Okuzaki
- Next Generation-Sequencing Core Facility, Bioinformatics Center, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka565-0871, Japan
| | - Hiroshi Matsuura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka565-0871, Japan
| | - Hyota Takamatsu
- Department of Clinical Research Center for Autoimmune Disease, Osaka Minami Medical Center, National Hospital Organization, Kawachinagano, Osaka586-8521, Japan
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Suita, Osaka565-0871, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka565-0871, Japan
| | - Tadamitsu Kishimoto
- Department of Immune Regulation, Immunology Frontier Research Center, Osaka University, Suita, Osaka565-0871, Japan
- Department of Immune Regulation, Center for Infectious Disease Education and Research, Osaka University, Suita, Osaka565-0871, Japan
| |
Collapse
|
8
|
Hosomi S, Irisawa T, Nakao S, Zha L, Kiyohara K, Kitamura T, Ogura H, Oda J. Association of sex with post-arrest care and outcomes after out-of-hospital cardiac arrest of initial shockable rhythm: a nationwide cohort study. Front Cardiovasc Med 2024; 10:1269199. [PMID: 38239877 PMCID: PMC10794357 DOI: 10.3389/fcvm.2023.1269199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/27/2023] [Indexed: 01/22/2024] Open
Abstract
Background Research has described differences in the provision of prehospital treatment for women who experience out-of-hospital cardiac arrest. However, studies have reported conflicting results regarding survival outcomes or in-hospital interventions between sexes. Thus, this study aimed to investigate the association of sex with survival outcomes and in-hospital treatments in Japan. Methods We retrospectively analyzed data from the Japanese Association for Acute Medicine-Out-of-Hospital Cardiac Arrest Registry. Patients aged ≥18 years who presented with a shockable rhythm at the scene between June 2014 and December 2020 were included in our analysis. Outcome measures were 30-day survival and in-hospital interventions. We compared the outcomes between the sexes using multivariable logistic regression. Results In total, 5,926 patients (4,270 men; 1,026 women) with out-of-hospital cardiac arrest were eligible for our analysis. The proportions of patients with 30-day survival outcomes were 39.5% (1685/4,270) and 37.4% (384/1,026) in the male and female groups, respectively (crude odds ratio, 0.92; 95% confidence interval, 0.80-1.06). Although there were no significant differences, survival outcomes tended to be better in women than in men in the multiple regression analysis (adjusted odds ratio: 1.38; 95% confidence interval: 0.82-2.33). Furthermore, there was no significant difference between the sexes in terms of patients who received extracorporeal cardiopulmonary resuscitation (adjusted odds ratio: 0.81; 95% confidence interval: 0.49-1.33) or targeted temperature management (adjusted odds ratio: 0.99; 95% confidence interval: 0.68-1.46). Conclusions After adjusting for prognostic factors, there were no differences in survival rates and in-hospital interventions between men and women.
Collapse
Affiliation(s)
- Sanae Hosomi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Taro Irisawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ling Zha
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kousuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women’s University, Tokyo, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
9
|
Homma H, Uchibori K, Kobori F, Kawai K, Azuma K, Suzuki S, Uchida K, Oda J. Elective surgery for liver injury and misinserted tube into the inferior vena cava associated with chest tube replacement: A case report. Acute Med Surg 2024; 11:e943. [PMID: 38500639 PMCID: PMC10946161 DOI: 10.1002/ams2.943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/13/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024] Open
Abstract
Background Several reports on organ injury and death due to incorrect chest tube insertion exist; however, reports on the chest tube penetrating the liver and reaching the inferior vena cava are limited. Case Presentation A 79-year-old man presented with a clamped tube because of massive bleeding from the tube following right chest tube replacement in the hospital of origin. The tube entered the inferior vena cava from the hepatic parenchyma via the right hepatic vein and was removed 15 h later because his hemodynamics stabilized. A ruptured pseudoaneurysm necessitated further transcatheter arterial embolism on the second hospitalization day, and the patient was transferred back to the referring hospital on day 17. Conclusion Liver injury caused by an inferior vena cava misinsertion-associated chest tube can be treated with elective surgery in anticipation of the tube's tamponade effect. However, due to the risk of rebleeding, imaging follow-up is necessary soon after surgery.
Collapse
Affiliation(s)
- Hiroshi Homma
- Department of Emergency and Critical Care MedicineTokyo Medical UniversityTokyoJapan
| | - Kenichiro Uchibori
- Department of Emergency and Critical Care MedicineTokyo Medical UniversityTokyoJapan
| | - Fumimasa Kobori
- Department of Emergency and Critical Care MedicineTokyo Medical UniversityTokyoJapan
| | - Kentaro Kawai
- Department of Emergency and Critical Care MedicineTokyo Medical UniversityTokyoJapan
| | - Kazunari Azuma
- Department of Emergency and Critical Care MedicineTokyo Medical UniversityTokyoJapan
| | - Shoji Suzuki
- Department of Emergency and Critical Care MedicineTokyo Medical UniversityTokyoJapan
| | - Kotaro Uchida
- Department of Emergency and Critical Care MedicineTokyo Medical UniversityTokyoJapan
| | - Jun Oda
- Department of Traumatology and Acute Critical MedicineOsaka UniversityOsakaJapan
| |
Collapse
|
10
|
Ito H, Nakamura Y, Togami Y, Onishi S, Nakao S, Ogura H, Oda J. Relationship between extravascular leakage and clinical outcome on computed tomography of isolated traumatic brain injury. Acute Med Surg 2024; 11:e931. [PMID: 38385145 PMCID: PMC10879720 DOI: 10.1002/ams2.931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/27/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Abstract
Aim This study investigated whether contrast extravasation on computed tomography (CT) angiography in patients with traumatic brain injury (TBI) is associated with death or surgical procedures. Methods Patients over 18 years old, directly brought in by ambulance with an isolated head injury and confirmed to have acute intracranial hemorrhage on a CT scan upon admission between 2010 and 2020, were included. The primary outcome was mortality, and the secondary outcome was neurosurgical procedures performed from admission to discharge from the intensive care unit. Multivariable logistic regression analyses were performed to evaluate the association between these outcomes and contrast extravasation. Results The analysis included 188 patients with a median age of 65 years, 123 men (65.4%), 34 deaths (18.1%), and 91 surgeries (48.4%). Among the 66 patients with contrast extravasation, 22 (33.3%) died and 47 (71.2%) required surgery. Among the 122 patients with no contrast extravasation, 12 (9.8%) died, and 44 (36.1%) required surgery. The presence or absence of extravascular leakage was associated with death (odds ratio, 3.6 [95% CI: 1.2-12.2]) and surgery (odds ratio, 7.6 [95% CI: 2.5-22.7]). Conclusion Contrast extravasation was associated with mortality and performance of surgery in patients with an isolated head injury.
Collapse
Affiliation(s)
- Hiroshi Ito
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Youhei Nakamura
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Yuki Togami
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Shinya Onishi
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Jun Oda
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
| |
Collapse
|
11
|
Shimizu K, Hirata H, Tokuhira N, Motooka D, Nakamura S, Ueda A, Tachino J, Koide M, Uchiyama A, Ogura H, Oda J. Dysbiosis of gut microbiota in patients with severe COVID-19. Acute Med Surg 2024; 11:e923. [PMID: 38213715 PMCID: PMC10781893 DOI: 10.1002/ams2.923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 12/16/2023] [Accepted: 12/28/2023] [Indexed: 01/13/2024] Open
Abstract
Aim Altered gut microbiota has been proposed as one of the causes of exacerbation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19) from the perspective of the gut-lung axis. We aimed to evaluate gut microbiota in mechanically ventilated patients with COVID-19 prior to using antibiotics. Methods We retrospectively selected for enrollment COVID-19 patients who required mechanical ventilation on admission but who had not used antibiotics before admission to observe the influence of SARS-Cov-2 on gut microbiota. Fecal samples were collected serially on admission and were evaluated by 16S rRNA gene deep sequencing. Results The phylum of Bacteroidetes decreased, and those of Firmicutes and Actinobacteria increased in COVID-19 patients compared with those in healthy controls (p < 0.001). The main commensals of Bacteroides, Faecalibacterium, and Blautia at the genus level were significantly decreased in the COVID-19 patients, and opportunistic bacteria including Corynebacterium, Anaerococcus, Finegoldia Peptoniphilus, Actinomyces, and Enterococcus were increased (p < 0.001). α-Diversity and β-diversity in COVID-19 patients significantly changed compared with those in the healthy controls. Conclusion The commensal gut microbiota were altered, and opportunistic bacteria increased in patients with severe COVID-19 who required mechanical ventilation on admission.
Collapse
Affiliation(s)
- Kentaro Shimizu
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Haruhiko Hirata
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of MedicineOsaka UniversityOsakaJapan
| | - Natsuko Tokuhira
- Intensive Care Unit, Osaka University HospitalOsaka UniversitySuitaJapan
| | - Daisuke Motooka
- Department of Infection Metagenomics, Research Institute for Microbial DiseasesOsaka UniversitySuitaJapan
| | - Shota Nakamura
- Department of Infection Metagenomics, Research Institute for Microbial DiseasesOsaka UniversitySuitaJapan
| | - Akiko Ueda
- Laboratory for Clinical Investigation, Osaka University HospitalOsaka UniversitySuitaJapan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Moe Koide
- Intensive Care Unit, Osaka University HospitalOsaka UniversitySuitaJapan
| | - Akinori Uchiyama
- Intensive Care Unit, Osaka University HospitalOsaka UniversitySuitaJapan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Jun Oda
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| |
Collapse
|
12
|
Matsumoto H, Ogura H, Oda J. Analysis of comprehensive biomolecules in critically ill patients via bioinformatics technologies. Acute Med Surg 2024; 11:e944. [PMID: 38596160 PMCID: PMC11002317 DOI: 10.1002/ams2.944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/23/2024] [Accepted: 03/10/2024] [Indexed: 04/11/2024] Open
Abstract
Each patient with a critical illness such as sepsis and severe trauma has a different genetic background, comorbidities, age, and sex. Moreover, pathophysiology changes dynamically over time even in the same patient. Therefore, individualized treatment is necessary to account for heterogeneity in patient backgrounds. Recently, the analysis of comprehensive biomolecular information using clinical specimens has revealed novel molecular pathological classifications called subtypes. In addition, comprehensive biomolecular information using clinical specimens has enabled reverse translational research, which is a data-driven approach to the identification of drug target molecules. The development of these methods is expected to visualize the heterogeneity of patient backgrounds and lead to personalized therapy.
Collapse
Affiliation(s)
- Hisatake Matsumoto
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Jun Oda
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
| |
Collapse
|
13
|
Nobe R, Nakao S, Nakagawa Y, Ogura H, Shimazu T, Oda J. Association between lung contusion volume and acute changes in fibrinogen levels: A single-center observational study. Acute Med Surg 2024; 11:e945. [PMID: 38558758 PMCID: PMC10979042 DOI: 10.1002/ams2.945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/28/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
Aim Organ tissue damage, including the lungs, may lead to acute coagulopathy. This study aimed to evaluate the association between lung contusion volume and serum fibrinogen level during the acute phase of trauma. Methods We conducted an observational study using electronic medical records at a tertiary-care center between January 2015 and December 2018. We included patients with lung contusions on hospital arrival. We used three-dimensional computed tomography to calculate lung contusion volumes. The primary outcome was the lowest fibrinogen level measured within 24 h of hospital arrival. We evaluated the association between lung contusion volume and outcome with multivariable linear regression analysis. Also, we calculated the sensitivity and specificity of lung contusion volume in patients with a serum fibrinogen level of ≤150 mg/dL. Results We identified 124 eligible patients. Their median age was 43.5 years, and 101 were male (81.5%). The median lung contusion volume was 10.9%. The median lowest fibrinogen level within 24 h from arrival was 188.0 mg/dL. After adjustment, lung contusion volume had a statistically significant association with the lowest fibrinogen level within 24 h from arrival (coefficient -1.6, 95% confidence interval -3.16 to -0.07). When a lung contusion volume of 20% was used as the cutoff, the sensitivity and specificity to identify fibrinogen depletion were 0.27 and 0.95, respectively. Conclusion Lung contusion volume was associated with the lowest fibrinogen level measured within 24 h from hospital arrival. Measuring lung contusion volume may help to identify patients with a progression of fibrinogen depletion.
Collapse
Affiliation(s)
- Ryosuke Nobe
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuita, OsakaJapan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuita, OsakaJapan
| | - Yuko Nakagawa
- Emergency and Critical Care CenterHyogo Prefectural Nishinomiya HospitalNishinomiyaJapan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuita, OsakaJapan
| | | | - Jun Oda
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuita, OsakaJapan
| |
Collapse
|
14
|
Nakamura Y, Shiozaki T, Ito H, Nakao S, Ogura H, Oda J. Long-Term Outcomes Over 20 Years in Persons With Persistent Disorders of Consciousness After Traumatic Brain Injury. Neurotrauma Rep 2023; 4:805-812. [PMID: 38028278 PMCID: PMC10664559 DOI: 10.1089/neur.2023.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
The long-term outcomes of patients with disorders of consciousness after traumatic brain injury (TBI) is unclear. We investigated the long-term outcomes over 20 years in patients who were in a persistent vegetative state (VS). We conducted a retrospective cohort study using a review of medical records and collected data by telephone and written interviews with patients and their families. We included patients who were treated for TBI at our hospital, between October 1996 and January 2003 and who were in a persistent VS, defined as a Disability Rating Scale (DRS) score of ≥22 at 1 month after TBI. The DRS was administered at 1 month, 6 months, 1 year, and then annually out to 20 years. We evaluated their clinical course until July 2021 with the DRS. We analyzed 35 patients in a persistent VS attributable to TBI. We were able to confirm the 20-year outcomes for 26 of the 35 patients (74%); at 20 years post-TBI, 19 (54%) patients were found to be deceased and 7 (20%) were alive. Over the 20-year study period, 23 of the 35 patients (65.7%) emerged from a persistent VS. Among the 35 patients in a persistent VS at 1 month post-TBI, 20 (57%) emerged from a persistent VS within 1 year, and 3 patients (8.6%) emerged from a persistent VS after more than a year after injury. DRS scores improved up to 9 years post-injury, whereas the change in DRS scores from 10 to 20 years post-injury was within ±1 point in all patients. We found that patients with persistent VS attributable to TBI may show improvement in functional disability up to 10 years post-injury. On the other hand, no substantial improvement in functional disability was observed after the 10th year.
Collapse
Affiliation(s)
- Youhei Nakamura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tadahiko Shiozaki
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroshi Ito
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| |
Collapse
|
15
|
Nakao S, Katayama Y, Kitamura T, Hirose T, Tachino J, Ishida K, Ojima M, Kiguchi T, Umemura Y, Kiyohara K, Oda J. Trends and characteristics of severe road traffic injuries in children: a nationwide cohort study in Japan. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02372-z. [PMID: 37847398 DOI: 10.1007/s00068-023-02372-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/12/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE The purpose of this study was to evaluate temporal trends of characteristics of severe road traffic injuries in children and identify factors associated with mortality using a nationwide database in Japan. METHODS We performed a retrospective analysis of Japan Trauma Data Bank (JTDB) from 2004 to 2018. We included patients with traffic injuries under the age of 18 who were hospitalized. The primary outcome was in-hospital mortality. We evaluated trends in characteristics and assessed factors associated with in-hospital mortality using a logistic regression analysis. RESULTS A total of 4706 patients were analyzed. The most common mechanism of injury was bicycle crash (34.4%), followed by pedestrian (28.3%), and motorcycle crash (21.3%). The overall in-hospital mortality was 11.2%. We found decreasing trends in motorcycle crash and in-hospital mortality and increasing trends in rear passenger seats in cars over the 15-year period. The following factors were associated with in-hospital mortality: car crash (aOR 1.69, 95%CI 1.18-2.40), pedestrian (aOR 1.50, 95%CI 1.13-1.99), motorcycle crash (aOR 1.42, 95%CI 1.03-1.95) [bicycle crash as a reference]; concomitant injuries to head/neck (aOR 5.06, 95%CI 3.81-6.79), thorax (aOR 2.34, 95%CI 1.92-2.87), abdomen (aOR 1.74, 95%CI 1.29-2.33), pelvis/lower-extremity (aOR 1.57, 95%CI 1.23-2.00), spine (aOR 3.01, 95%CI 2.02-4.43); and 5-year increase in time period (aOR 0.80, 95%CI 0.70-0.91). CONCLUSIONS We found decreasing trends in motorcycle crash and in-hospital mortality, increasing trends in rear passenger seats in cars over the 15-year period, and factors associated with in-hospital mortality such as type of mechanisms and concomitant injuries. Strengthening child road safety measures, particularly for rear passenger seats in vehicles, is imperative to enhance our dedication to injury prevention.
Collapse
Affiliation(s)
- Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Division of Environmental Medicine and Population Sciences, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kenichiro Ishida
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masahiro Ojima
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takeyuki Kiguchi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Yutaka Umemura
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| |
Collapse
|
16
|
Nakao S, Katayama Y, Kitamura T, Tanaka K, Hirose T, Tachino J, Iwami T, Masui J, Domi H, Shimazu T, Oda J, Matsuoka T. Assessing the impact of COVID-19 pandemic on ambulance transports for self-harm: a population-based study in Osaka Prefecture, Japan. BMJ Open 2023; 13:e074903. [PMID: 37699632 PMCID: PMC10503339 DOI: 10.1136/bmjopen-2023-074903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic might have affected emergency medical services transports for self-harm in Japan. However, the available data are insufficient to fully understand the pandemic's impact on ambulance transports due to self-harm. This study aimed to investigate the change in the incidence of ambulance transports for self-harm from 2018 to 2021 and to identify vulnerable age groups during the pandemic. DESIGN A population-based observational study using a database from the Osaka Prefectural Government. SETTING The database covers the entire area of Osaka Prefecture and included information on ambulance transports and hospital details. PARTICIPANTS Ambulance transport of patients due to self-harm from 2018 through 2021 was investigated. PRIMARY OUTCOME MEASURES The primary outcome was the incidence of ambulance transport for self-harm. RESULTS We analysed 10 843 patients. Their median age was 38 years, and 69.0% were female. We observed an increasing trend of the incidence rate in cases per 100 000 population per year from 29.4 in 2018 to 31.2 in 2021. However, after adjusting for age group, sex and month, there was no difference in the incidence of ambulance transport due to self-harm in 2019 (adjusted incidence rate ratio (aIRR) 1.007; 95% CI 0.955 to 1.063), 2020 (aIRR 1.041; 95% CI 0.987 to 1.098) and 2021 (aIRR 1.022; 95% CI 0.968 to 1.078), compared with 2018. We observed no difference in 21-day mortality from 2018 through 2021. In the age group of 20-29 years, despite no difference in 2019 compared with 2018, we found an 11.7% increase in the incidence of ambulance transport due to self-harm in 2020 (aIRR 1.117; 95% CI 1.002 to 1.245) and no difference in 2021. CONCLUSIONS There was no difference in the incidence of ambulance transport due to self-harm and 21-day mortality from 2018 through 2021. However, the incidence rate of ambulance transport due to self-harm in 2020 increased in the age group of 20-29 years.
Collapse
Affiliation(s)
- Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
| | - Tetsuhisa Kitamura
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Department of Social and Environmental Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
| | - Kenta Tanaka
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Department of Social and Environmental Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
| | - Taku Iwami
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Health Service, Kyoto University, Kyoto, Japan
| | - Jun Masui
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Department of Emergency Medicine, Tane General Hospital, Osaka, Japan
| | - Hisaya Domi
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
| | | | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
| | - Tetsuya Matsuoka
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Rinku General Medical Center, Izumisano, Osaka, Japan
| |
Collapse
|
17
|
Tanaka K, Katayama Y, Kitamura T, Dohmi H, Masui J, Hirose T, Nakao S, Tachino J, Zha L, Sobue T, Oda J, Matsuoka T. Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on Emergency Patients Hospitalized With Cardiocerebrovascular Diseases in Osaka Prefecture, Japan - A Population-Based Study. Circ J 2023; 87:1240-1248. [PMID: 37532531 DOI: 10.1253/circj.cj-23-0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
BACKGROUND Little is known about the transport and outcomes of emergency patients with cardiocerebrovascular diseases in Japan before and during the COVID-19 pandemic.Methods and Results: Data were extracted from a population-based registry in Osaka, Japan, from 2019 to 2021. There were almost no differences in the numbers of emergency patients hospitalized with myocardial infarction, stroke, or heart failure or their deaths. However, the number of cases of difficulty obtaining patient acceptance by hospitals increased in 2020 and 2021 compared with 2019. CONCLUSIONS The numbers of emergency patients hospitalized with cardiocerebrovascular diseases and their deaths in Osaka were not affected by the COVID-19 epidemic.
Collapse
Affiliation(s)
- Kenta Tanaka
- Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
| | - Hisaya Dohmi
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
- Osaka Prefectural Government
| | - Jun Masui
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
- Osaka Prefectural Government
- Department of Emergency Medicine, Tane General Hospital
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine
| | - Ling Zha
- Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine
| | - Tomotaka Sobue
- Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine
| | - Tetsuya Matsuoka
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
| |
Collapse
|
18
|
Onishi S, Matsumoto H, Sugihara F, Ebihara T, Matsuura H, Osuka A, Okuzaki D, Ogura H, Oda J. Combination of HBA1, TTR, and SERPINF2 in plasma defines phenotype correlated with severe burn outcome. iScience 2023; 26:107271. [PMID: 37502255 PMCID: PMC10368932 DOI: 10.1016/j.isci.2023.107271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/19/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
Recent advancements in proteomics allow for the concurrent identification and quantification of multiple proteins. This study aimed to identify proteins associated with severe burn pathology and establish a clinically useful molecular pathology classification. In a retrospective observational study, blood samples were collected from severe burn patients. Proteins were measured using mass spectrometry, and prognosis-related proteins were extracted by comparing survivors and non-survivors. Enrichment and ROC analyses evaluated the extracted proteins, followed by latent class analysis. Measurements were performed on 83 burn patients. In the non-survivor group, ten proteins significantly changing on the day of injury were associated with metabolic processes and toxin responses. ROC analysis identified HBA1, TTR, and SERPINF2 with AUCs > 0.8 as predictors of 28-day mortality. Latent class analysis classified three molecular pathotypes, and plasma mass spectrometry revealed ten proteins associated with severe burn prognosis. Molecular pathotypes based on HBA1, TTR, and SERPINF2 significantly correlated with outcomes.
Collapse
Affiliation(s)
- Shinya Onishi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hisatake Matsumoto
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
- Institute for Open and Transdisciplinary Research Initiatives, Osaka University, 1-1 Yamadaoka, Suita, Osaka 565-0871, Japan
- Center for Infectious Disease Education and Research (CiDER), Osaka University, 2-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Fuminori Sugihara
- Core Instrumentation Facility, Immunology Frontier Research Center and Research Institute for Microbial Diseases, 3-1 Yamadaoka, Suita, Osaka 565-0871, Japan
- Center for Infectious Disease Education and Research (CiDER), Osaka University, 2-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Takeshi Ebihara
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hiroshi Matsuura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
- Osaka Prefectural Nakakawachi Emergency and Critical Care Center, 3-4-13 Nishiiwata, Higashiosaka, Osaka 578-0947, Japan
| | - Akinori Osuka
- Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Health Care Organization Chukyo Hospital, 1-1-10 Sanjo, Minami-ku, Nagoya, Aichi 457-8510, Japan
| | - Daisuke Okuzaki
- Laboratory of Human Immunology (Single Cell Genomics), WPI Immunology Research Center, Osaka University, 3-1 Yamadaoka, Suita, Osaka 565-0871, Japan
- Genome Information Research Center, Research Institute for Microbial Diseases, Osaka University, 3-1 Yamadaoka, Suita, Osaka 565-0871, Japan
- Institute for Open and Transdisciplinary Research Initiatives, Osaka University, 1-1 Yamadaoka, Suita, Osaka 565-0871, Japan
- Center for Infectious Disease Education and Research (CiDER), Osaka University, 2-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| |
Collapse
|
19
|
Shimoyama K, Endo A, Shimazui T, Tagami T, Yamakawa K, Hayakawa M, Ogura T, Hirayama A, Yasunaga H, Oda J. Association between obesity and mortality in critically ill COVID-19 patients requiring invasive mechanical ventilation: a multicenter retrospective observational study. Sci Rep 2023; 13:11961. [PMID: 37488189 PMCID: PMC10366113 DOI: 10.1038/s41598-023-39157-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/20/2023] [Indexed: 07/26/2023] Open
Abstract
This study aimed to determine whether obesity and disease outcomes are associated in patients with critically-ill coronavirus disease 2019 (COVID-19) requiring invasive mechanical ventilation (IMV). This retrospective observational study using Japanese multicenter registry data included COVID-19 patients who required IMV and were discharged between January and September 2020. The patients were divided into the obese (body mass index [BMI] ≥ 25 kg/m2) and nonobese (BMI < 25 kg/m2) groups. Logistic regression models were used to analyze the association between obesity and disease outcomes. The primary outcome was in-hospital mortality; the secondary outcome was venovenous extracorporeal membrane oxygenation (VV-ECMO) implementation. Altogether, 477 patients were enrolled (obese, n = 235, median BMI, 28.2 kg/m2; nonobese, n = 242, median BMI, 22.4 kg/m2). Obesity was significantly associated with lower in-hospital mortality in the unadjusted logistic regression model (odds ratio 0.63; 95% confidence interval, 0.42-0.97; p = 0.033), but not with mortality in the adjusted logistic regression model using age, sex, and Charlson Comorbidity Index as covariates (p = 0.564). Obesity was not associated with VV-ECMO implementation in both unadjusted and adjusted models (unadjusted, p = 0.074; adjusted, p = 0.695). Obesity was not associated with outcomes in COVID-19 patients requiring IMV. Obesity may not be a risk factor for poor outcomes in these patients.
Collapse
Affiliation(s)
- Keiichiro Shimoyama
- Department of Emergency and Critical Care Medicine, Tokyo Medical University Hospital, 6-7-1, Nisi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
- Department of Acute Critical Care Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Takashi Shimazui
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu, Chiba, 292-8535, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimachi, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, N14W5, Kita-ku, Sapporo, 060-8648, Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Center, Imperial Gift Foundation SAISEIKAI, Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya, Tochigi, 321-0974, Japan
| | - Atsushi Hirayama
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-15, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hong, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, 2-15, Yamadaoka, Suita, Osaka, 565-0871, Japan
| |
Collapse
|
20
|
Imamura Y, Matsumoto H, Imamura J, Matsumoto N, Yamakawa K, Yoshikawa N, Murakami Y, Mitani S, Nakagawa J, Yamada T, Ogura H, Oda J, Shimazu T. Ultrasound stimulation of the vagal nerve improves acute septic encephalopathy in mice. Front Neurosci 2023; 17:1211608. [PMID: 37529234 PMCID: PMC10388538 DOI: 10.3389/fnins.2023.1211608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/21/2023] [Indexed: 08/03/2023] Open
Abstract
Septic encephalopathy (SE) is characterized by symptoms such as coma, delirium, and cognitive dysfunction, and effective therapeutic interventions for SE remain elusive. In this study, we aimed to investigate the potential alleviating effects of vagal nerve stimulation (VNS) on SE-associated signs. To evaluate our hypothesis, we utilized a mouse model of SE induced by intraperitoneal injection of lipopolysaccharide (0.3 mg per mouse) and administered noninvasive, high-frequency ultrasound VNS. To assess the efficacy of ultrasound VNS, we measured inflammation-related molecules, including the α7 nicotinic acetylcholine receptor (α7nAChR) expression in peritoneal macrophages and plasma interleukin 1β (IL-1β) levels. Consistent with our hypothesis, SE mice exhibited reduced α7nAChR expression in macrophages and elevated IL-1β levels in the blood. Remarkably, VNS in SE mice restored α7nAChR expression and IL-1β levels to those observed in control mice. Furthermore, we evaluated the effects of VNS on survival rate, body temperature, and locomotor activity. SE mice subjected to VNS demonstrated a modest, yet significant, improvement in survival rate, recovery from hypothermia, and increased locomotor activity. To investigate the impact on the brain, we examined the hippocampus of SE mice. In control mice, VNS increased the expression of c-fos, a marker of neuronal electrical excitability, in the hippocampus. In SE mice, VNS led to the restoration of aberrant firing patterns in hippocampal neurons. Additionally, proteomic analysis of hippocampal tissue in SE mice revealed abnormal increases in two proteins, tissue factor (TF) and acyl-CoA dehydrogenase family member 9 (ACAD9), which returned to control levels following VNS. Collectively, our findings support the value of exploring the beneficial effects of ultrasound VNS on SE.
Collapse
Affiliation(s)
- Yukio Imamura
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
- Organization for Research Initiatives and Development, Doshisha University, Kyoto, Japan
- Department of Architectural and Environmental Planning, Graduate School of Engineering, Kyoto University, Kyoto, Japan
- Department of Hygiene and Public Health, Kansai Medical University, Osaka, Japan
| | - Hisatake Matsumoto
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Jun Imamura
- Molex Corporation, Ltd., Yamato, Kanagawa, Japan
| | - Naoya Matsumoto
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kazuma Yamakawa
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Nao Yoshikawa
- Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuki Murakami
- Department of Hygiene and Public Health, Kansai Medical University, Osaka, Japan
- Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoko Mitani
- Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Faculty of Acupuncture and Moxibustion, Meiji University of Integrative Medicine, Kyoto, Japan
| | - Junichiro Nakagawa
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomoki Yamada
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| |
Collapse
|
21
|
Mitsuhara C, Togami Y, Hirose T, Nakao S, Ito H, Matsumoto H, Ogura H, Okuzaki D, Oda J. Whole-blood ribonucleic acid sequencing analysis in methemoglobinemia: a case report. J Med Case Rep 2023; 17:238. [PMID: 37296483 DOI: 10.1186/s13256-023-03976-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/27/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION Methemoglobinemia is a condition in which methemoglobin is increased and the oxygen carrying capacity of tissues is decreased, causing a lack of oxygen to the whole body. RNA (ribonucleic acid) sequencing technologies have made it possible to systematically examine how the human transcriptome responds to invasive pathologies. To our knowledge, no previous studies have reported the results of RNA sequencing in a patient with methemoglobinemia. We describe the analysis of RNAs from the whole blood of a patient with methemoglobinemia. CASE PRESENTATION A 31-year-old Japanese man was brought to our hospital with symptoms of dyspnea due to inhalation of gas from an acetic acid phosphonitrate storage tank at a factory. The nitrogen oxide concentration measured around the storage tank was over 2500 ppm, and he witnessed orange-brown smoke at that time. After entering the area and taking a few breaths, he suddenly became unwell, with dyspnea and numbness in his extremities. He was evacuated from the area within a few minutes, at which time he was suffering from whole-body cyanosis and was still aware of the above symptoms. On arrival at the hospital, his respiration rate was 18 breaths/minute, and his SpO2 ranged from 80% to 85% on 15 L/minute of oxygen by mask (2.5 hours postexposure). Arterial blood gas testing revealed a methemoglobin level of 23.1%. After the administration of methylene blue, the patient's methemoglobin level normalized and his symptoms improved. Chest X-ray and chest computed tomography showed no evidence of pulmonary edema or interstitial pneumonia, and no other abnormal findings were observed. RNA sequencing was performed on the blood samples obtained at the time of the visit, with the blood sample collected on day 5 used as a control. To our knowledge, the present study is the first to describe the analysis of RNAs from the whole blood of a patient with methemoglobinemia. The RNA sequencing analysis showed that an activated "hydrogen peroxide catabolic process" may be associated with the pathogenesis of methemoglobinemia. CONCLUSION The results reported in the present study may explain the pathogenesis of methemoglobinemia.
Collapse
Affiliation(s)
- Chikai Mitsuhara
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Yuki Togami
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
- Department of Acute Medicine and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan.
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Hiroshi Ito
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Hisatake Matsumoto
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Daisuke Okuzaki
- Laboratory of Human Immunology (Single Cell Genomics), WPI Immunology Research Center, Osaka University, Osaka, Japan
- Genome Information Research Center, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| |
Collapse
|
22
|
Ebihara T, Shimizu K, Mitsuyama Y, Ogura H, Oda J. Correction: Association between high cardiac output at altitude and acute mountain sickness: preliminary study on Mt. Fuji. J Physiol Anthropol 2023; 42:7. [PMID: 37208712 DOI: 10.1186/s40101-023-00324-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Affiliation(s)
- Takeshi Ebihara
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2‑15 Yamadaoka, Suita City, Osaka, 565‑0871, Japan.
| | - Kentaro Shimizu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2‑15 Yamadaoka, Suita City, Osaka, 565‑0871, Japan
| | - Yumi Mitsuyama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2‑15 Yamadaoka, Suita City, Osaka, 565‑0871, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2‑15 Yamadaoka, Suita City, Osaka, 565‑0871, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2‑15 Yamadaoka, Suita City, Osaka, 565‑0871, Japan
| |
Collapse
|
23
|
Ebihara T, Shimizu K, Mitsuyama Y, Ogura H, Oda J. Association between high cardiac output at altitude and acute mountain sickness: preliminary study on Mt. Fuji. J Physiol Anthropol 2023; 42:6. [PMID: 37055843 PMCID: PMC10099929 DOI: 10.1186/s40101-023-00322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/29/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Acute mountain sickness (AMS) affects around 30% of people climbing Mt. Fuji, but its pathogenesis is incompletely understood. The influence of a rapid ascent to high altitude by climbing and summiting Mt. Fuji on cardiac function in the general population is unknown, and its association with altitude sickness has not been clarified. METHODS Subjects climbing Mt. Fuji were included. Heart rate, oxygen saturation, systolic blood pressure, cardiac index (CI) and stroke volume index were measured multiple times at 120 m as baseline values and at Mt. Fuji Research Station (MFRS) at 3,775 m. Each value and its difference from the baseline value (Δ) of subjects with AMS (defined as Lake Louise Score [LLS] ≥ 3 with headache after sleeping at 3,775 m) were compared with those of non-AMS subjects. RESULTS Eleven volunteers who climbed from 2,380 m to MFRS within 8 h and stayed overnight at MFRS were included. Four suffered AMS. Compared with the non-AMS subjects, CI in the AMS subjects was significantly higher than that before sleeping (median [interquartile range]: 4.9 [4.5, 5.0] vs. 3.8 [3.4, 3.9] mL/min/m2; p = 0.04), and their ΔCI was significantly higher before sleeping (1.6 [1.4, 2.1] vs. 0.2 [0.0, 0.7] mL/min/m2; p < 0.01) and after sleeping (0.7 [0.3, 1.7] vs. -0.2 [-0.5, 0.0] mL/min/m2; p < 0.01). ΔCI in the AMS subjects dropped significantly after sleeping versus before sleeping (3.8 [3.6, 4.5] vs. 4.9 [4.5, 5.0] mL/min/m2; p = 0.04). CONCLUSIONS Higher values of CI and ΔCI were observed at high altitude in the AMS subjects. A high cardiac output might be associated with the development of AMS.
Collapse
Affiliation(s)
- Takeshi Ebihara
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
| | - Kentaro Shimizu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Yumi Mitsuyama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| |
Collapse
|
24
|
Hosomi S, Zha L, Kiyohara K, Kitamura T, Irisawa T, Ogura H, Oda J. Sex disparities in prehospital advanced cardiac life support in out-of-hospital cardiac arrests in Japan. Am J Emerg Med 2023; 64:67-73. [PMID: 36442266 DOI: 10.1016/j.ajem.2022.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Sex disparities in out-of-hospital cardiac arrest (OHCA) care processes have been reported. This study aimed to investigate the association between sex and prehospital advanced cardiac life support (ACLS) interventions provided by emergency medical services in Japan. METHODS We analyzed data from January 1, 2013, to December 31, 2020, from the All-Japan Utstein Registry of patients with OHCA aged ≥18 years who were resuscitated by bystanders. The primary outcomes were prehospital ACLS interventions, including advanced airway management (AAM) and epinephrine administration. Sex-based disparities in receiving prehospital ACLS interventions were assessed via multivariable logistic regression analyses. RESULTS Among 314,460 eligible patients, females with OHCA received fewer prehospital ACLS interventions than males: 83,571/187,834 (44.5%) males vs. 55,086/126,626 (43.5%) females (adjusted odds ratio [AOR] = 0.94, 95% confidence interval [CI] = 0.93-0.96) for AAM and 60,097/187,834 (32.0%) males vs. 35,501/126,626 (28.0%) females (AOR = 0.84, 95% CI = 0.83-0.85) for epinephrine administration. Similar results were also obtained in the subgroup analysis (groups included patients aged 18-74 years and ≥75 years and those with cardiac origin, ventricular fibrillation (VF), non-VF, non-family member witnessed, and family member witnessed). CONCLUSION Compared with males, females were less likely to receive prehospital ACLS. Emergency medical service staff must be made aware of this disparity, and off-the-job training on intravenous cannulation or AAM replacement must be conducted. Investigation of the impact of sex disparity on OHCA care processes can facilitate planning of future public health policies to improve survival outcomes.
Collapse
Affiliation(s)
- Sanae Hosomi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Japan; Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Japan.
| | - Ling Zha
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Japan
| | - Taro Irisawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Japan.
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Japan.
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Japan
| |
Collapse
|
25
|
Ojima M, Ishida K, Katayama Y, Hirose T, Nakao S, Tachino J, Noda T, Umemura Y, Kiguchi T, Kiyohara K, Matsuyama T, Kitamura T, Oda J, Ohnishi M. Impact of the COVID-19 pandemic on epidemiology, treatment, and outcome of major trauma in Japan in 2020: a retrospective observational nationwide registry-based study. Acute Med Surg 2023; 10:e817. [PMID: 36698916 PMCID: PMC9849826 DOI: 10.1002/ams2.817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/01/2023] [Indexed: 01/21/2023] Open
Abstract
Aim The nationwide impact of the coronavirus disease (COVID-19) pandemic on major trauma in Japan is unknown. The nationwide registry-based data of the Japanese Trauma Data Bank were analyzed to elucidate the impact of COVID-19 on the epidemiology, treatment, and outcomes of major trauma patients. Methods Among patients transported directly from the injury site by ambulance with an Injury Severity Score of ≥16, we compared patients managed from April to December in 2019 to those managed from April to December in 2020. Results In total, 9792 patients were included in this study (2019, n = 5194; 2020, n = 4598). There were no significant differences in age or sex, but there were significant differences between 2019 and 2020 in the rates of "self-injury (suicide)", "motor vehicle accident", "fall from height", "fall down", and "fall to the ground", which are factors associated with patient age. Injury severity in 2019 and 2020 did not differ to a statistically significant extent, but the rate of major spinal injury increased. The time of prehospital care significantly increased in 2020 compared to 2019. There was no noticeable change in hospital treatment or in-hospital mortality between 2019 and 2020. Conclusion This study suggests that the COVID-19 pandemic might have altered the injuries of major trauma; however, medical services for major trauma were well supplied in Japan in 2020.
Collapse
Affiliation(s)
- Masahiro Ojima
- Department of Acute Medicine and Critical Care Medical CenterNational Hospital Organization Osaka National HospitalOsakaJapan
| | - Kenichiro Ishida
- Department of Acute Medicine and Critical Care Medical CenterNational Hospital Organization Osaka National HospitalOsakaJapan
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Tomohiro Noda
- Department of Traumatology and Critical Care MedicineOsaka Metropolitan University School of MedicineOsakaJapan
| | - Yutaka Umemura
- Department of Emergency and Critical CareOsaka General Medical CenterOsakaJapan
| | - Takeyuki Kiguchi
- Department of Emergency and Critical CareOsaka General Medical CenterOsakaJapan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home EconomicsOtsuma Women's UniversityTokyoJapan
| | - Tasuku Matsuyama
- Department of Emergency MedicineKyoto Prefectural University of MedicineKyotoJapan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Jun Oda
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Mitsuo Ohnishi
- Department of Acute Medicine and Critical Care Medical CenterNational Hospital Organization Osaka National HospitalOsakaJapan
| |
Collapse
|
26
|
Nakao S, Ito H, Katayama Y, Kitamura T, Hirose T, Tachino J, Ogura H, Oda J. Mapping publications using the Japan Trauma Data Bank: Scoping review of the international literature. Acute Med Surg 2023; 10:e847. [PMID: 37261375 PMCID: PMC10227637 DOI: 10.1002/ams2.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 06/02/2023] Open
Abstract
The purpose of this study was to describe the characteristics of published international literature using the Japan Trauma Data Bank (JTDB). We undertook a scoping review of studies using data from JTDB. We carried out a systematic search of the following databases on November 21, 2022, using search terms that covers trauma registries in Japan: MEDLINE, Web of Science, CINAHL, and Cochrane Library. Two authors independently abstracted the data. We included all original articles written in English. We identified 166 studies from the 456 included articles. From 2010 to 2016, the annual number of published articles was less than 10. In 2017, there were 10 articles published (6.0%). This increased to 18 (10.8%) in 2018, 21 (12.7%) in 2019, 28 (16.9%) in 2020, 33 (19.9%) in 2021, and 37 (22.3%) in 2022. Most articles (n = 138, 83.1%) reported in-hospital mortality as the primary outcome. There were more articles on the adult population (n = 86, 51.8%) than those on the pediatric population (n = 21, 12.7%). Twenty-one articles (12.7%) specified a mechanism of injury for the study population, and three articles (1.8%) focused on burns. Most articles did not specify injury sites for the study population (n = 108, 65.1%) and the most common injury site described in publications was the head (n = 21, 12.7%), followed by the abdomen (n = 13, 7.8%). We observed an increase in international publications using the JTDB and highlighted the major topics and knowledge gaps. Our findings could encourage studies to explore less studied areas in research using the JTDB.
Collapse
Affiliation(s)
- Shunichiro Nakao
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Hiroshi Ito
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Jun Oda
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| |
Collapse
|
27
|
Yoshimura J, Ogura H, Oda J. Can Gram staining be a guiding tool for optimizing initial antimicrobial agents in bacterial infections? Acute Med Surg 2023; 10:e862. [PMID: 37362034 PMCID: PMC10290512 DOI: 10.1002/ams2.862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
The emergence of multidrug-resistant organisms poses a significant threat to global public health, making the optimization of antimicrobial use crucial. Antimicrobial therapy is often initiated in emergency rooms (ERs) and intensive care units (ICUs), where patients are at high risk of infection. Prompt antimicrobial selection is essential in these facilities, and point-of-care testing can guide the appropriate initial antimicrobial therapy. Gram staining, a quick and inexpensive method, was previously used for point-of-care testing by physicians in the 1980s but was discontinued in 1988 in the United States. However, in Japan, the clinical practice of Gram stain-based antimicrobial therapy by physicians has continued in a limited number of hospitals. Several studies undertaken in Japan have shown that Gram staining carried out by trained physicians can reduce the overuse of broad-spectrum antimicrobial agents in ERs and ICUs without worsening patients' outcomes. Gram stain-based antimicrobial therapy reduced unnecessary use of carbapenems in the ER. Furthermore, Gram staining has been shown to significantly reduce the overuse of broad-spectrum antimicrobials without worsening clinical cure and mortality for patients with ventilator-associated pneumonia in the ICU. The classic technique of Gram staining has regained its usefulness through persistent clinical practice in Japan. It is hoped that Japanese researchers in this field will demonstrate to the world the efficacy of the classic technique of Gram staining in addressing this critical problem. Gram staining carried out by trained physicians could serve as a valuable means of optimizing antimicrobial treatment in ERs and ICUs.
Collapse
Affiliation(s)
- Jumpei Yoshimura
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Jun Oda
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| |
Collapse
|
28
|
Katayama Y, Tanaka K, Kitamura T, Dohmi H, Masui J, Hirose T, Nakao S, Tachino J, Oda J, Matsuoka T. Incidence and outcome of patients with difficulty in hospital acceptance during COVID-19 pandemic in Osaka Prefecture, Japan: A population-based descriptive study. Acute Med Surg 2023; 10:e880. [PMID: 37564634 PMCID: PMC10410119 DOI: 10.1002/ams2.880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/24/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023] Open
Abstract
Aim The impact of the coronavirus disease (COVID-19) pandemic on the emergency medical service system in Japan has not been fully revealed. The purpose of this study was to determine the impact of the COVID-19 pandemic in 2021 on the difficulty in hospital acceptance of patients and patient outcome in Osaka Prefecture. Methods This study was a descriptive epidemiological study with a 3-year study period from January 2019 to December 2021. We included patients who were transported by ambulance and had registered in the Osaka Emergency Information Research Intelligent Operation Network (ORION) system. The primary end-point of this study was the difficulty in hospital acceptance by month, and the secondary outcome was the mortality of patients who experience difficulty in hospital acceptance in each year. Results We included 1,302,646 cases in this study. The proportion of cases with difficulty in hospital acceptance was 2.74% (12,829/468,709) in 2019, 3.74% (15,527/414,987) in 2020, and 5.09% (21,311/418,950) in 2021. The crude odds ratio for 2020 was 1.38 (95% confidence interval, 1.35-1.41) and for 2021 was 1.90 (95% confidence interval, 1.86-1.95). In 2019, 218 patients with difficulty in hospital acceptance had died by 21 days after hospitalization, whereas the number increased to 405 in 2020 and 750 in 2021. Conclusion The number of patients experiencing difficulty in hospital acceptance during the COVID-19 pandemic in Osaka Prefecture increased, and patient outcomes were worse than before the pandemic.
Collapse
Affiliation(s)
- Yusuke Katayama
- The Working Group to Analyse the Emergency Medical Care System in Osaka PrefectureOsakaJapan
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Kenta Tanaka
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Tetsuhisa Kitamura
- The Working Group to Analyse the Emergency Medical Care System in Osaka PrefectureOsakaJapan
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Hisaya Dohmi
- The Working Group to Analyse the Emergency Medical Care System in Osaka PrefectureOsakaJapan
- Osaka Prefectural GovernmentOsakaJapan
| | - Jun Masui
- The Working Group to Analyse the Emergency Medical Care System in Osaka PrefectureOsakaJapan
- Osaka Prefectural GovernmentOsakaJapan
- Department of Emergency MedicineTane General HospitalOsakaJapan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Jun Oda
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Tetsuya Matsuoka
- The Working Group to Analyse the Emergency Medical Care System in Osaka PrefectureOsakaJapan
| |
Collapse
|
29
|
Umemura Y, Nishida T, Yamakawa K, Ogura H, Oda J, Fujimi S. Anticoagulant therapies against sepsis-induced disseminated intravascular coagulation. Acute Med Surg 2023; 10:e884. [PMID: 37670904 PMCID: PMC10475981 DOI: 10.1002/ams2.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/20/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
Disseminated intravascular coagulation (DIC) is a frequent but lethal complication in sepsis. Anticoagulant therapies, such as heparin, antithrombin, activated protein C, and recombinant human-soluble thrombomodulin, were expected to regulate the progression of coagulopathy in sepsis. Although a number of randomized controlled trials (RCTs) have evaluated the survival effects of these therapies over the past few decades, there remains no consistent evidence showing a significant survival benefit of anticoagulant therapies. Currently, anticoagulant therapies are not conducted as a standard treatment against sepsis in many countries and regions. However, most of these RCTs were performed overall in patients with sepsis but not in those with sepsis-induced DIC, who were theoretically the optimal target population of anticoagulants. Actually, multiple lines of evidence from observational studies and meta-analyses of the RCTs have suggested that anticoagulant therapies might reduce mortality only when used in septic DIC. In addition, the severity of illness is another essential factor that maximally affects the efficacy of the therapy. Therefore, to provide evidence on the true effect of anticoagulant therapies, the next RCTs must be designed to enroll only patients with sepsis-induced overt DIC and a high severity of illness. To prepare these future RCTs, a novel scientific infrastructure for accurate detection of patients who can receive maximal benefit from anticoagulant therapies also needs to be established.
Collapse
Affiliation(s)
- Yutaka Umemura
- Division of Trauma and Surgical Critical CareOsaka General Medical CenterOsakaJapan
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Takeshi Nishida
- Division of Trauma and Surgical Critical CareOsaka General Medical CenterOsakaJapan
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Kazuma Yamakawa
- Department of Emergency MedicineOsaka Medical and Pharmaceutical UniversityTakatsuki, OsakaJapan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Jun Oda
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Satoshi Fujimi
- Division of Trauma and Surgical Critical CareOsaka General Medical CenterOsakaJapan
| |
Collapse
|
30
|
Ito H, Nakamura Y, Togami Y, Onishi S, Nakao S, Iba J, Ogura H, Oda J. Association of Extravascular Leakage on Computed Tomography Angiography with Fibrinogen Levels at Admission in Patients with Traumatic Brain Injury. Neurotrauma Rep 2022; 4:3-13. [PMID: 36636245 PMCID: PMC9811953 DOI: 10.1089/neur.2022.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Extravascular leakage on computed tomography (CT) angiography in patients with traumatic brain injury (TBI) is associated with hematoma expansion, functional prognosis, subsequent surgery, and death. Fresh frozen plasma (FFP) administration is often necessary to treat coagulation disorders associated with TBI. This study aimed to determine the relationship between the presence of extravascular leakage on contrast-enhanced head CT, fibrinogen level at admission, and FFP administration in patients with TBI. The medical records of patients with TBI ≥18 years of age referred to our hospital between January 2010 and December 2020 were examined retrospectively. Patients who underwent contrast-enhanced CT immediately after admission were selected, and the presence or absence of extravascular leakage, fibrinogen level at admission, and percentage of patients who required FFP administration within 24 h of admission were examined; 172 patients were included. Multi-variable linear regression analysis was performed to determine the effects of contrast extravasation on fibrinogen levels at admission and was adjusted for age, sex, systolic blood pressure, time from injury to admission, Marshall CT score, Glasgow Coma Scale score at admission, Injury Severity Score, and need for emergency surgery; the regression coefficient was -19.8. The effect of extravasation on FFP administration within 24 h of admission was analyzed using logistic regression while adjusting for age, systolic blood pressure, Marshall CT score, need for emergency surgery, and fibrinogen level at admission. The odds ratio of contrast extravasation was 7.08 after adjustment. Extravascular leakage is associated with fibrinogen levels at admission and FFP administration within 24 h of admission.
Collapse
Affiliation(s)
- Hiroshi Ito
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.,Address correspondence to: Hiroshi Ito, PhD, Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita, Osaka 565-0871, Japan;
| | - Youhei Nakamura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuki Togami
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinya Onishi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jiro Iba
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
31
|
Hosomi S, Zha L, Kiyohara K, Kitamura T, Komukai S, Sobue T, Oda J. Impact of the COVID-19 pandemic on out-of-hospital cardiac arrest outcomes in older adults in Japan. Resusc Plus 2022; 12:100299. [PMID: 36093311 PMCID: PMC9444504 DOI: 10.1016/j.resplu.2022.100299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/25/2022] Open
Abstract
Aim The coronavirus disease (COVID-19) pandemic has negatively affected access to healthcare and treatment. This study aimed to explore the impact of the COVID-19 pandemic on older adults with out-of-hospital cardiac arrest (OHCA) in Japan, a country with a super-aging society. Methods This secondary analysis of the All-Japan Utstein Registry included patients aged 65 years and older with bystander-witnessed OHCA between January 1, 2005, and December 31, 2020. Survival outcomes were compared by time period using multivariable logistic regression analyses. The primary outcome measured was the one-month survival rate with neurologically favorable outcomes. Results Before the COVID-19 pandemic, survival outcomes were steadily improving, and 32,024 patients in 2019 and 31,894 in 2020 were eligible for analysis. The proportions of conventional cardiopulmonary resuscitation and shock by public-access automated external defibrillators were lower in 2020 than in 2019 (6.7% versus 5.7%, p < 0.001 and 2.5% versus 2.1%, p < 0.001, respectively). Compared to 2019, the one-month survival after OHCA and prehospital return of spontaneous circulation decreased significantly in 2020 than in 2019 (7.7% versus 6.6%, adjusted odds ratio [AOR]: 0.88, 95% confidence interval [CI]: 0.83–0.94, and 16.8% versus 14.9%, AOR: 0.87, 95% CI: 0.83–0.91, respectively). The proportion of neurologically favorable outcomes also decreased, but the decrease was not statistically significant (3.4% versus 2.8%, AOR: 0.92, 95% CI: 0.83–1.01). Conclusion In this population-focused, bystander-witnessed study regarding OHCA, the analysis of nationwide registry data revealed that the COVID-19 pandemic was associated with reduced survival among older adults with OHCA in Japan.
Collapse
|
32
|
Nakao S, Katayama Y, Kitamura T, Tanaka K, Hirose T, Tachino J, Ishida K, Ojima M, Kiguchi T, Umemura Y, Kiyohara K, Oda J. Characteristics and outcomes of severe sports-related injury in children and adults: a nationwide cohort study in Japan. Eur J Trauma Emerg Surg 2022; 49:893-901. [PMID: 36261734 DOI: 10.1007/s00068-022-02144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/11/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Understanding epidemiological patterns in patients with severe sports-related injuries between children and adults is important for injury prevention. We ought to describe the characteristics and outcomes of patients with severe sports-related injuries and compare the characteristics between children and adults. METHODS We conducted a retrospective analysis of the Japan Trauma Data Bank (JTDB). We included patients with sports-related injury and an ISS of at least 16, who were admitted between 2004 and 2018. We compared characteristics between children (< 18 years) and adults (≥ 18 years). We performed a multivariable logistic regression analysis to compare in-hospital mortality. RESULTS We identified 1369 eligible patients (children, n = 326; adults, n = 1043). The most common season was April-June and July-September in children (28.5% and 27.9%) and January-March in adults (42.1%). Injuries to the head/neck (58.9% vs. 40.8%, p < 0.001) and abdomen (16.0% vs. 8.3%, p < 0.001) were significantly more frequent in children than adults, while injuries to the thorax (8.0% vs. 27.2%, p < 0.001), pelvis/lower extremity (0.6% vs. 6.0%, p < 0.001), and spine (23.9% vs. 35.3%, p < 0.001) were less frequent in children. We did not observe a statistically significant difference in in-hospital mortality between children and adults. CONCLUSIONS We conducted a comprehensive analysis of severe sports-related injuries using a nationwide trauma database and demonstrated different patterns of severe sports-related injuries in children and adults.
Collapse
Affiliation(s)
- Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenta Tanaka
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kenichiro Ishida
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masahiro Ojima
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takeyuki Kiguchi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Yutaka Umemura
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| |
Collapse
|
33
|
Katayama Y, Kanehara A, Yamashita Y, Kitamura T, Oda J. The Characteristics and Outcomes of Patients Transported by Ambulance Due to Ambulatory Care Sensitive Condition: A Population-Based Descriptive Study in Osaka, Japan. Front Public Health 2022; 10:911675. [PMID: 35844890 PMCID: PMC9279932 DOI: 10.3389/fpubh.2022.911675] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/06/2022] [Indexed: 12/28/2022] Open
Abstract
Background Ambulatory care sensitive conditions (ACSCs) are defined as clinical conditions for which the risk of emergency hospital admission can be reduced by timely and effective ambulatory care. However, the actual status of patients with ACSCs who are transported by ambulance and their outcomes have not been fully elucidated. The purpose of this study was to reveal characteristics and outcomes of patients with ACSCs who were transported by ambulance using population-based registry data in Osaka, Japan. Methods This descriptive epidemiological study was conducted in the 5-year period from January 2016 to December 2020, and included patients who were transported by ambulance due to sudden illness. In this study, ACSC was further classified into acute ACSCs, chronic ACSCs, and preventable ACSCs based on the ICD-10. The number of patients transported by ambulance for ACSCs per 100,000 population in each age group was calculated for each year. In addition, Poisson regression models were used to assess the trend in the number of ACSCs patients transported by ambulance. Results A total of 1,572,152 patients were included in this study (acute ACSCs, n = 69,621; chronic ACSCs, n = 12,250; preventable ACSCs, n = 96,036; and non-ACSCs, n = 1,394,245). The overall median age was 71 years (95% confidence interval [CI], 46-92). Patients with acute ACSCs (median age: 76 years [IQR: 60-84]) and chronic ACSCs (median age: 80 years [IQR: 72-87]) were older, while patients with preventable ACSCs were younger (median age: 66 years [95%CI: 3-81]) and included a high proportion of children (33.3%, 32,002/96,036). Regarding the outcome after treatment at the emergency department, 42.6% (670,392/1,572.152) of patients were hospitalized, while 82.3% (10,079/12,250) of patients with chronic ACSCs were hospitalized. No change was observed in adults (P = 0.001) or elderly (age ≥65 years) individuals (P = 0.376) with preventable ACSCs, however, among children, the number increased until 2019 (732.5) and then decreased in 2020 (371.8) (P = 0.392). Conclusion In this study, patients with chronic ACSCs were predominantly elderly, while patients with preventable ACSCs were polarized between children and the elderly. Among patients with preventable ACSCs, there was no change over time in adults and children, but there was a marked decrease among the elderly after 2020.
Collapse
Affiliation(s)
- Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- *Correspondence: Yusuke Katayama
| | - Atsushi Kanehara
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuya Yamashita
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| |
Collapse
|
34
|
Hosomi S, Kitamura T, Sobue T, Zha L, Kiyohara K, Matsuyama T, Oda J. Association between Timing of Epinephrine Administration and Outcomes of Traumatic Out-of-Hospital Cardiac Arrest following Traffic Collisions. J Clin Med 2022; 11:jcm11123564. [PMID: 35743634 PMCID: PMC9224800 DOI: 10.3390/jcm11123564] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/28/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
The effects of epinephrine administration timing on patients with out-of-hospital cardiac arrest (OHCA) following traffic collisions are unknown. We analyzed the 2013-2019 All-Japan Utstein Registry data of 2024 such patients aged ≥18 years who were resuscitated by emergency medical service (EMS) personnel or bystanders and then transported to medical institutions. Time from 119 call to epinephrine administration was classified into quartiles: Q1 (6-21 min), Q2 (22-26 min), Q3 (27-34 min), and Q4 (35-60 min). Multivariable logistic regression analysis was used to assess the effects of epinephrine administration timing on one-month survival after OHCA. Overall, the one-month survival rates were 3.2% (15/466) in Q1, 1.1% (5/472) in Q2, 1.9% (11/577) in Q3, and 0.2% (1/509) in Q4. Additionally, the one-month survival rate decreased significantly in the Q4 group (adjusted odds ratio, 0.07; 95% confidence interval, 0.01-0.57) compared with the Q1 group, and the probability of one-month survival decreased as the time from the EMS call to epinephrine administration increased (p-value for trend = 0.009). Only four patients (0.9% [4/466]) with the earliest epinephrine administration showed a good neurological outcome.
Collapse
Affiliation(s)
- Sanae Hosomi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita 565-0871, Japan;
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan; (T.K.); (T.S.); (L.Z.)
- Correspondence: ; Tel.: +81-6-6879-5707
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan; (T.K.); (T.S.); (L.Z.)
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan; (T.K.); (T.S.); (L.Z.)
| | - Ling Zha
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan; (T.K.); (T.S.); (L.Z.)
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women’s University, 12 Sanban-cho, Chiyoda-ku, Tokyo 102-8357, Japan;
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan;
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita 565-0871, Japan;
| |
Collapse
|
35
|
Onishi S, Ebihara T, Togami Y, Matsubara T, Matsumoto H, Osuka A, Ogura H, Oda J. Growth Differentiation Factor-15 Correlates with Mortality and Severity in Severe Burns. Shock 2022; 57:211-217. [PMID: 35616608 DOI: 10.1097/shk.0000000000001925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Growth differentiation factor-15 (GDF-15) is expressed in almost all tissues of the body and is necessary for the body's defense response to stress such as inflammation. It has been reported to be associated with incidence and mortality in many diseases, including systemic inflammatory response syndromes. There are no reports on GDF-15 in burns. The purpose of this study was to investigate the trend of GDF-15 in blood in patients with severe burns and to determine its relationship with severity and mortality. METHODS This was a retrospective, observational, single-center study. The level of GDF-15 in the blood was measured and compared with clinical parameters, including prognosis. Time points for sample collection were the day of injury, 4 days after injury, and 1 week after injury. RESULTS Eighty-three patients were enrolled in the study. At all time points, GDF-15 levels in the nonsurvivor group were significantly higher than those in the survivor group. In the analysis using the ROC curve for 28-day survival, the AUC of the GDF-15 value on the day of injury was 0.798, which was higher than those of % total body surface area, burn index, and Sequential Organ Failure Assessment (SOFA) score. GDF-15 levels correlated positively with SOFA score, and the relationship became stronger along with the time course of severe burn. CONCLUSIONS In the acute phase of severe burn, GDF-15 levels were associated with mortality and SOFA scores.
Collapse
Affiliation(s)
- Shinya Onishi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Ebihara
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuki Togami
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tsunehiro Matsubara
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hisatake Matsumoto
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akinori Osuka
- Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Aichi, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
36
|
Ito H, Hosomi S, Koyama Y, Matsumoto H, Imamura Y, Ogura H, Oda J. Sepsis-Associated Encephalopathy: A Mini-Review of Inflammation in the Brain and Body. Front Aging Neurosci 2022; 14:912866. [PMID: 35711904 PMCID: PMC9195626 DOI: 10.3389/fnagi.2022.912866] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Sepsis is defined as a life-threatening multi-organ dysfunction triggered by an uncontrolled host response to infectious disease. Systemic inflammation elicited by sepsis can cause acute cerebral dysfunction, characterized by delirium, coma, and cognitive dysfunction, known as septic encephalopathy. Recent evidence has reported the underlying mechanisms of sepsis. However, the reasons for the development of inflammation and degeneration in some brain regions and the persistence of neuroinflammation remain unclear. This mini-review describes the pathophysiology of region-specific inflammation after sepsis-associated encephalopathy (SAE), clinical features, and future prospects for SAE treatment. The hippocampus is highly susceptible to inflammation, and studies that perform treatments with antibodies to cytokine receptors, such as interleukin-1β, are in progress. Future development of clinically applicable therapies is expected.
Collapse
Affiliation(s)
- Hiroshi Ito
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Sanae Hosomi
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
- *Correspondence: Sanae Hosomi,
| | - Yoshihisa Koyama
- Department of Neuroscience and Cell Biology, Osaka University Graduate School of Medicine, Osaka, Japan
- Addiction Research Unit, Osaka Psychiatric Research Center, Osaka Psychiatric Medical Center, Osaka, Japan
| | - Hisatake Matsumoto
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yukio Imamura
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| |
Collapse
|
37
|
Sakurai A, Ohta S, Oda J, Muguruma T, Abe T, Morimura N. ABCD approach at the #7119 center, telephone triage system in Tokyo, Japan; a retrospective cohort study. BMC Emerg Med 2022; 22:66. [PMID: 35439949 PMCID: PMC9020061 DOI: 10.1186/s12873-022-00625-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background The algorithm and protocol of the #7119 telephone triage in Tokyo, Japan, had been originally established and consists of three steps. In this study, we investigated the outcome of patients treated with physiological abnormality (ABCD approach: A, airway; B, breathing; C, circulation, and D, dysfunction of central nervous system) in step 2 during the #7119 telephone triage and clarified the meaning of evaluation of this approach. Methods We retrospectively reviewed data from the Tokyo Fire Department from January 2016 to December 2017. Almost all the patients triaged using the ABCD approach were transferred to the hospital by ambulance and assigned severity by a physician. We divided patients into groups with combinations of 15 patterns including A, B, C, D, AB, AC, AD, BC, BD, CD, ABC, ABD, ACD, BCD, and ABCD. We compared the proportion of severe cases in each group using a Fisher's exact test, followed by residual analysis. Results We analyzed 13,793 cases triaged using the ABCD approach. In this analysis, 31% of total cases were assessed as severe cases. Groupwise analysis showed that the proportion of severe cases was significantly higher in the AD, BC, CD, ABD, and ABCD groups, while it was significantly less in the C and AB groups than in the total cases. Conclusion At the #7119 telephone triage, we can pick up the severe cases by the ABCD approach. This may contribute to the prompt transportation of severe patients to hospitals by dispatching ambulance cars using the #7119 telephone triage methods.
Collapse
Affiliation(s)
- Atsushi Sakurai
- Emergency Telephone Consultation Centre, Tokyo Medical Association, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8328, Japan. .,Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Oyaguchikamichou 30-1, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Sachiko Ohta
- Department of Pharmaceutical and Medical Business Sciences, Nihon Pharmaceutical University, 3-15-9 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan.,Research and Analysis, Center for Health Service Outcome Research and Development, 23-17-408 Sakuragaokashou, Shibuya-ku, Tokyo, 150-0031, Japan
| | - Jun Oda
- Emergency Telephone Consultation Centre, Tokyo Medical Association, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8328, Japan.,Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Takashi Muguruma
- Emergency Telephone Consultation Centre, Tokyo Medical Association, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8328, Japan.,Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 3-9 Kanazawa-ku Fukuura, Yokoyama-city, Kanagawa, 236-0004, Japan
| | - Takeru Abe
- Emergency Telephone Consultation Centre, Tokyo Medical Association, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8328, Japan.,Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Minami-ku Urafunemachi, Yokoyama city, Kanagawa, 232-0024, Japan
| | - Naoto Morimura
- Emergency Telephone Consultation Centre, Tokyo Medical Association, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8328, Japan.,Department of Emeregency Medicine, Teikyo Univeristy School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
| |
Collapse
|
38
|
Hosomi S, Kitamura T, Sobue T, Zha L, Kiyohara K, Oda J. Epidemiology and Outcome of Pediatric Out-of-Hospital Cardiac Arrest after Traffic Collision in Japan: A Population-Based Study. J Clin Med 2022; 11:jcm11030831. [PMID: 35160282 PMCID: PMC8836665 DOI: 10.3390/jcm11030831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 01/27/2023] Open
Abstract
The epidemiological and clinical characteristics, treatments, and outcomes of patients with traumatic out-of-hospital cardiac arrests (OHCAs) following traffic collisions have not been adequately investigated in Japan. We analyzed the All-Japan Utstein Registry data of 918 pediatric patients aged < 20 years with OHCAs following traffic collisions who were resuscitated by bystanders or emergency medical service personnel and were subsequently transported to hospitals between 2013 and 2019. Multiple logistic regression analysis was used to assess factors potentially associated with 1-month survival after OHCA. The 1-month survival rate was 3.3% (30/918), and the rate of neurologically favorable outcomes was 0.7% (60/918). The proportion of 1-month survival of all OHCAs after traffic collision origin did not significantly increase (from 1.9% (3/162) in 2013 to 4.5% (5/111) in 2019), and the adjusted odds ratio (OR) for a 1-year increment was 1.13 (95% confidence interval (CI) 0.93 to 1.37). In a multivariate analysis, ventricular fibrillation arrests and pulseless electrical activity (PEA) were significant predictors of 1-month outcome after OHCAs due to traffic collision. From a large OHCA registry in Japan, we demonstrated that 1-month survival after OHCAs due to traffic collision origin was approximately 3%, and some children even gained full recovery of neurological function.
Collapse
Affiliation(s)
- Sanae Hosomi
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, 2-15, Yamada-oka, Suita 565-0871, Japan; (S.H.); (J.O.)
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita 565-0871, Japan; (T.S.); (L.Z.)
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita 565-0871, Japan; (T.S.); (L.Z.)
- Correspondence: ; Tel.: +81-6-6879-3922
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita 565-0871, Japan; (T.S.); (L.Z.)
| | - Ling Zha
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita 565-0871, Japan; (T.S.); (L.Z.)
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women’s University, 12 Sanban-cho, Chiyoda-ku, Tokyo 102-8357, Japan;
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, 2-15, Yamada-oka, Suita 565-0871, Japan; (S.H.); (J.O.)
| |
Collapse
|
39
|
Nakao S, Katayama Y, Tanaka K, Kitamura T, Hirose T, Tachino J, Iwami T, Shimazu T, Oda J, Matsuoka T. Impact of the
COVID
‐19 pandemic and subsequent social restrictions on ambulance calls for suicidal and nonsuicidal self‐harm: a population‐based study in Osaka prefecture, Japan. Acute Med Surg 2022; 9:e787. [PMID: 36187449 PMCID: PMC9500421 DOI: 10.1002/ams2.787] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
Aim Self‐harm is a common ambulance call and is potentially affected by the COVID‐19 pandemic. The aim of this study was to investigate whether the incidence of ambulance transport due to self‐harm increased in 2020. Methods We undertook a population‐based observational study using a database from the Osaka prefectural government. Ambulance transport of patients due to self‐harm from 2016 through 2020 was investigated. We estimated adjusted incidence rate ratios using a Poisson regression model to compare the annual incidence rates of ambulance transport in 2017–2020 with those in 2016. We also provided age‐stratified analysis. Results We analyzed 13,648 patients. There was no difference in the incidence of ambulance transport due to self‐harm in 2017, 2018, 2019, and 2020 compared with 2016. In the age group of 20–29 years, despite no difference in 2017–2019 compared with 2016, we found a 13.8% increase in the incidence of ambulance transport due to self‐harm in 2020 (adjusted incidence rate ratio, 1.138; 95% confidence interval, 1.025–1.265). Conclusions Although there was no difference in the incidence of ambulance transport due to self‐harm in 2017–2019, that in 2020 increased in the age group of 20–29 years.
Collapse
Affiliation(s)
- Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Kenta Tanaka
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Taku Iwami
- Department of Preventive Services, School of Public Health Kyoto University Kyoto Japan
| | | | - Jun Oda
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | | |
Collapse
|
40
|
Aida K, Azuma K, Mishima S, Ishii Y, Suzuki S, Oda J, Honma H. Potentially inappropriate medications at admission among elderly patients transported to a tertiary emergency medical institution in Japan. Acute Med Surg 2022; 9:e748. [PMID: 35386514 PMCID: PMC8976156 DOI: 10.1002/ams2.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/05/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Aim Potentially inappropriate medications (PIMs) have been reported to be associated with lower adherence, higher rates of adverse events, and higher health‐care costs in elderly patients with high comorbidity. However, inappropriate prescribing has not been adequately reported in studies of patients transported to tertiary care hospitals. In this study, we investigated PIMs at the time of admission, on the basis of the prescription status of elderly patients admitted to a tertiary emergency room (ER). Methods We included 316 patients (168 men and 148 women, aged 75–97 years) who were admitted to our ER from September 2018 to August 2019, whose prescriptions were available on admission. Drugs that met the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) criteria version 2 were defined as PIMs. The primary outcome was the proportion of older adults taking at least one PIM at admission. Results The proportion of patients taking PIMs at admission was 57% (n = 179). The most common PIMs were benzodiazepines, proton pump inhibitors, and nonsteroidal anti‐inflammatory drugs. The total number of medications prescribed at admission, prescriptions from multiple institutions, and prescriptions from clinics were the risk factors for PIMs at admission (P < 0.01, P < 0.001, and P < 0.001, respectively). Conclusion We must be careful to avoid inappropriate prescribing for patients transported to tertiary care hospitals who have numerous prescriptions at the time of admission, patients who receive prescriptions from multiple medical institutions, and patients who receive prescriptions from clinics.
Collapse
Affiliation(s)
- Kenta Aida
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Kazunari Azuma
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Shiro Mishima
- Department of Medical Safety Management Tokyo Medical University Tokyo Japan
| | - Yuri Ishii
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Shoji Suzuki
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Hiroshi Honma
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| |
Collapse
|
41
|
Hosomi S, Zha L, Kiyohara K, Kitamura T, Irisawa T, Ogura H, Oda J. Survival following an out‐of‐hospital cardiac arrest in Japan in 2020 versus 2019 according to the cause. Acute Med Surg 2022; 9:e777. [PMID: 36051446 PMCID: PMC9420169 DOI: 10.1002/ams2.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/07/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sanae Hosomi
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine Osaka University Suita Japan
| | - Ling Zha
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine Osaka University Suita Japan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics Otsuma Women's University Tokyo Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine Osaka University Suita Japan
| | - Taro Irisawa
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| |
Collapse
|
42
|
Shimoyama K, Azuma K, Oda J. A patient with COVID-19 and bleeding complications due to neurofibromatosis type 1 during VV-ECMO: A case report. Medicine (Baltimore) 2021; 100:e28094. [PMID: 34941051 PMCID: PMC8702218 DOI: 10.1097/md.0000000000028094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The many deaths from coronavirus disease (COVID-19) since 2019 have caused global concern. Effective treatment has not yet been established; supportive care is the main treatment. It has been suggested that veno-venous extracorporeal membrane oxygenation (VV-ECMO) may be effective in severe cases that do not respond to ventilator management. PATIENT CONCERNS AND DIAGNOSIS We report the case of a 68-year-old woman with severe respiratory failure due to COVID-19 who was treated with VV-ECMO but suffered from bleeding complications. She presented with multiple café-au-lait lesions and neurofibromas on her skin and was diagnosed pathologically as having neurofibromatosis type 1(NF1). INTERVENTIONS AND OUTCOMES Although she received appropriate anticoagulation therapy with heparin at the initiation of VV-ECMO, she had 5 episodes of severe bleeding, each requiring transcatheter arterial embolization and massive transfusion. In patients with NF1, vascular fragility has been noted due to vascular infiltration of neurofibromas and degeneration of vascular structures. Therefore, the causes of frequent bleeding complications may be related to the fragility of blood vessels in patients with NF1. VV-ECMO in patients with NF1 is likely to result in frequent bleeding complications and the need for massive transfusion. LESSON We propose non-anticoagulation treatment strategy for the management of VV-ECMO in patients with NF1. Especially under the COVID-19 pandemic, more careful consideration should be given to the indications for VV-ECMO in patients with NF1.
Collapse
|
43
|
Aida K, Azuma K, Mishima S, Ishii Y, Suzuki S, Oda J. Potentially inappropriate medications at discharge among elderly patients at a single tertiary emergency medical institution in Japan: a retrospective cross-sectional observational study. Acute Med Surg 2021; 8:e711. [PMID: 34876989 PMCID: PMC8628299 DOI: 10.1002/ams2.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 11/15/2022] Open
Abstract
Aim Potentially inappropriate medications (PIMs) are associated with a lower medication adherence and a higher incidence of adverse events and medical costs among elderly patients. The current study aimed to examine the prescription status of elderly patients transported to tertiary emergency medical institutions to compare the proportion of elderly patients using PIMs at admission and discharge and to investigate the characteristics of PIMs at discharge and their associated factors. Methods In total, 264 patients aged 75 years or older who were transferred to and discharged from the emergency room at Tokyo Medical University Hospital, a tertiary care hospital, from September 2018 to August 2019 were included in this study. We quantified the number of PIMs at admission and discharge based on the Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP) criteria version 2. The primary outcomes were the proportion of elderly patients taking at least one PIM at admission and discharge. Results The proportions of patients taking PIMs at admission and discharge were 55% (n = 175) and 28% (n = 74), respectively. Old age, greater number of PIMs at admission, and greater number of medications at discharge were directly associated with PIMs at discharge. Conclusions Admission to tertiary care hospitals resulted in a lower number of prescribed PIMs. Elderly patients with a higher number of PIMs at admission and higher number of medications at discharge might have been prescribed with PIMs.
Collapse
Affiliation(s)
- Kenta Aida
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Kazunari Azuma
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Shiro Mishima
- Department of Medical Safety Management Tokyo Medical University Tokyo Japan
| | - Yuri Ishii
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Shoji Suzuki
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Jun Oda
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| |
Collapse
|
44
|
Shimoyama K, Azuma K, Nakamura I, Oda J. Prediction of the prognosis of patients with bacteremia caused by encapsulated organisms using spleen volume: A retrospective study. Acute Med Surg 2021; 8:e698. [PMID: 34721882 PMCID: PMC8535436 DOI: 10.1002/ams2.698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/12/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022] Open
Abstract
Aim The spleen plays an important role in the immune response, and patients with impaired spleen function are at risk of overwhelming post‐splenectomy infection. This study investigated whether the spleen volume could predict the prognosis of patients with bacteremia caused by encapsulated organisms. Methods This was a single‐center, retrospective observational study at Tokyo Medical University Hospital. Twenty patients with encapsulated bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and Capnocytophaga canimorsus) detected in blood culture between January 2017 and July 2020 were included in the study and categorized into two groups: survive and nonsurvive groups. We investigated the association between spleen volume (SV), spleen volume index (SVI), and in‐hospital mortality. The SVI was defined as: SVI‐H, spleen volume cm3/height m; SVI‐BW, spleen volume cm3/body weight kg; and SVI‐A, spleen volume cm3 × age/100. Results The number of patients in the survive group was 17, and that of the non‐survive group was 3. The SV and SVI were smaller in the nonsurvive group than in the survive group (P < 0.05). The calculated the SV cut‐off for the prediction of prognosis was 36 cm3 with a sensitivity of 94.1% and specificity of 66.7% with a positive predictive value of 94.1% and a negative predictive value of 66.7%. Conclusions The SV and SVI could be used to predict the prognosis of bacteremia caused by encapsulated organisms. If the spleen volume as measured by computed tomography is small, more intensive treatment should be considered.
Collapse
Affiliation(s)
- Keiichiro Shimoyama
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Kazunari Azuma
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Itaru Nakamura
- Department of Infection Prevention and Control Tokyo Medical University Tokyo Japan
| | - Jun Oda
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| |
Collapse
|
45
|
Morimura N, Mizobata Y, Sugita M, Takeda S, Kiyozumi T, Shoko T, Inoue Y, Otomo Y, Sakurai A, Koido Y, Tanabe S, Okumura T, Yamasawa F, Tanaka H, Kinoshi T, Kaku K, Matsuda K, Kitamura N, Hayakawa T, Kuroda Y, Kuroki Y, Sasaki J, Oda J, Inokuchi M, Kakuta T, Arai S, Sato N, Matsuura H, Nozawa M, Osamura T, Yamashita K, Okudera H, Kawana A, Koshinaga T, Hirano S, Sugawara E, Kamata M, Tajiri Y, Kohno M, Suzuki M, Nakase H, Suehiro E, Yamase H, Otake H, Morisaki H, Ozawa A, Takahashi S, Otsuka K, Harikae K, Kishi K, Mizuno H, Nakajima H, Ueta H, Nagayama M, Kikuchi M, Yokota H, Shimazu T, Yukioka T. Medicine at mass gatherings: current progress of preparedness of emergency medical services and disaster medical response during 2020 Tokyo Olympic and Paralympic Games from the perspective of the Academic Consortium (AC2020). Acute Med Surg 2021; 8:e626. [PMID: 33552526 PMCID: PMC7852170 DOI: 10.1002/ams2.626] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/23/2020] [Indexed: 01/08/2023] Open
Abstract
Mass gatherings are events characterized by “the concentration of people at a specific location for a specific purpose over a set period of time that have the potential to strain the planning and response resources of the host country or community.” Previous reports showed that, as a result of the concentration of people in the limited area, injury and illness occurred due to several factors. The response plan should aim to provide timely medical care to the patients and to reduce the burden on emergency hospitals, and to maintain a daily emergency medical services system for residents of the local area. Although a mass gathering event will place a significant burden on the local health‐care system, it can provide the opportunity for long‐term benefits of public health‐care and improvement of daily medical service systems after the end of the event. The next Olympic and Paralympic Games will be held in Tokyo, during which mass gatherings will occur on a daily basis in the context of the coronavirus disease (COVID‐19) epidemic. The Academic Consortium on Emergency Medical Services and Disaster Medical Response Plan during the Tokyo Olympic and Paralympic Games in 2020 (AC2020) was launched 2016, consisting of 28 academic societies in Japan, it has released statements based on assessments of medical risk and publishing guidelines and manuals on its website. This paper outlines the issues and countermeasures for emergency and disaster medical care related to the holding of this big event, focusing on the activities of the academic consortium.
Collapse
Affiliation(s)
- Naoto Morimura
- Japanese Association for Acute Medicine Tokyo Japan.,The Scientific Research Group of Ministry of Health, Labor and Welfare of Japan Tokyo Japan
| | | | | | - Satoshi Takeda
- The Education and Training Working Group of AC2020 Tokyo Japan.,AED Foundation of Japan Tokyo Japan
| | | | - Tomohisa Shoko
- The Education and Training Working Group of AC2020 Tokyo Japan
| | - Yoshiaki Inoue
- The Education and Training Working Group of AC2020 Tokyo Japan
| | - Yasuhiro Otomo
- The Scientific Research Group of Ministry of Health, Labor and Welfare of Japan Tokyo Japan.,Japanese Association for the Surgery of Trauma Tokyo Japan
| | | | - Yuichi Koido
- Japanese Association for Disaster Medicine Tokyo Japan
| | - Seizan Tanabe
- Japanese Association for Disaster Medicine Tokyo Japan
| | - Tetsu Okumura
- Japanese Society for Clinical Toxicology Tokyo Japan
| | | | | | - Tomoya Kinoshi
- Japanese Association of First Aid and Emergency Medicine Kyoto Japan
| | - Koki Kaku
- Japanese Society for Infection Prevention and Control Tokyo Japan
| | - Kiyoshi Matsuda
- Japan Prehospital Trauma Evaluation and Care Council Tokyo Japan
| | | | | | - Yasuhiro Kuroda
- Japanese Society of Intensive Care Medicine Tokyo Japan.,Japanese Society of Reanimatology Ube Japan
| | - Yumiko Kuroki
- Japanese Society for Clinical Toxicology Tokyo Japan
| | - Junichi Sasaki
- Japanese Society for Burn Injuries Tokyo Japan.,Japanese Association for Infectious Diseases Tokyo Japan
| | - Jun Oda
- Japanese Society for Burn Injuries Tokyo Japan
| | | | | | | | - Noriaki Sato
- Japanese Association for Emergency Nursing Tokyo Japan
| | | | | | | | | | - Hiroshi Okudera
- Japanese Association of First Aid and Emergency Medicine Kyoto Japan
| | - Akihiko Kawana
- Japanese Association for Infectious Diseases Tokyo Japan
| | | | | | - Erisa Sugawara
- Japanese Society for Infection Prevention and Control Tokyo Japan
| | | | | | | | | | | | | | | | | | | | - Akiko Ozawa
- Japanese Society of Anesthesiologists Kobe Japan
| | - Sho Takahashi
- Japanese Society of Psychiatry and Neurology Tokyo Japan
| | - Kotaro Otsuka
- Japan Society of Plastic and Reconstructive Surgery Tokyo Japan
| | - Kiyokazu Harikae
- Japan Prehospital Trauma Evaluation and Care Council Tokyo Japan
| | - Kazuo Kishi
- Japan Society of Plastic and Reconstructive Surgery Tokyo Japan
| | - Hiroshi Mizuno
- Japan Society of Plastic and Reconstructive Surgery Tokyo Japan
| | | | | | | | | | - Hiroyuki Yokota
- The Scientific Research Group of Ministry of Health, Labor and Welfare of Japan Tokyo Japan
| | | | | | | |
Collapse
|
46
|
Oda J, Tanabe S, Nishimura T, Muguruma T, Matsuyama S, Sugawara Y, Ogura S. JAAM Nationwide Survey on the response to the first wave of COVID-19 in Japan. Part I: How to set up a treatment system in each hospital. Acute Med Surg 2020; 7:e614. [PMID: 33335739 PMCID: PMC7733145 DOI: 10.1002/ams2.614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/12/2020] [Indexed: 11/11/2022] Open
Abstract
Aim To clarify how the medical institutions overcame the first wave of coronavirus disease 2019 (COVID-19) in Japan and to discuss its impact on the medical labor force. Methods We analyzed questionnaire data from the end of May 2020 from 180 hospitals (102,578 beds) certified by the Japanese Association for Acute Medicine. Results Acute (emergency) medicine physicians treated severe COVID-19 patients in more than half of hospitals. Emergency medical teams consisted of acute medicine physicians and other specialists. Frontline acute care physicians were concerned about their risk of infection in 80% of hospitals, and experienced stress due to a lack of personal protective equipment. Twenty-six of the 143 hospitals that had a mental health check/consultation system in place indicated that there was a doctor who experienced mental health problems. Of the 37 hospitals without a system, only one hospital was aware of the presence of a doctor complaining of mental health problems. Conclusion Acute care physicians and physicians in other departments experienced high levels of stress as they fought to arrange COVID-19 treatment teams and inpatient COVID-19 wards for infected patients. Medical materials and equipment may be sufficient for a second or third wave; however, active support is needed for the physical and mental care of medical staff. Mental health problems may be missed in facilities without mental check and consultation system.
Collapse
Affiliation(s)
- Jun Oda
- Labor Management Committee Japanese Association for Acute Medicine (JAAM) Tokyo Japan.,Department of Emergency and Critical Care Medicine Tokyo Medical University Shinjuku Japan
| | - Seizan Tanabe
- Labor Management Committee Japanese Association for Acute Medicine (JAAM) Tokyo Japan.,Foundation for Ambulance Service Development Emergency Life-Saving Technique Academy of Tokyo Tokyo Japan
| | - Tetsuro Nishimura
- Labor Management Committee Japanese Association for Acute Medicine (JAAM) Tokyo Japan.,Department of Traumatology and Critical Care Medicine Graduate School of Medicine Osaka City University Osaka Japan
| | - Takashi Muguruma
- Labor Management Committee Japanese Association for Acute Medicine (JAAM) Tokyo Japan.,Advanced Critical Care and Emergency Center Yokohama City University Medical Center Yokohama Japan
| | - Shigenari Matsuyama
- Labor Management Committee Japanese Association for Acute Medicine (JAAM) Tokyo Japan.,Department of Emergency and Critical Care Medicine Hyogo Emergency Medical Center Kobe Japan
| | - Yoko Sugawara
- Labor Management Committee Japanese Association for Acute Medicine (JAAM) Tokyo Japan.,Department of Emergency and Critical Care Medicine Tokyo Saiseikai Central Hospital Tokyo Japan
| | - Shinji Ogura
- Labor Management Committee Japanese Association for Acute Medicine (JAAM) Tokyo Japan.,Department of Emergency and Disaster Medicine Gifu University Graduate School of Medicine Gifu Japan
| |
Collapse
|
47
|
Kobori F, Azuma K, Mishima S, Oda J. Validation of Psoas Muscle Index as a predictor of successful extubation in elderly intensive care patients: a retrospective cohort study. Acute Med Surg 2020; 7:e598. [PMID: 33209334 PMCID: PMC7659975 DOI: 10.1002/ams2.598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 10/13/2020] [Indexed: 11/18/2022] Open
Abstract
Aim Extubation failure–associated factors have not been investigated in elderly patients. We hypothesized that psoas cross‐sectional area, an emerging indicator of frailty, can be a predictor of extubation outcomes. Methods This retrospective study analyzed data from patients admitted between January and April 2016 at the mixed medical intensive care unit (ICU) of the Tokyo Medical University Hospital. Patients were considered eligible if aged 65 years or older, required intubation at the emergency room, and were admitted to ICU for over 24 h. Overall, 39 ICU patients were eligible and categorized into two groups: extubation success (n = 24) and extubation failure (n = 15) groups. The psoas cross‐sectional area was measured at the third lumbar level on computer tomography images. Psoas Muscle Index (PMI) was defined as the psoas cross‐sectional area/height2. Primary outcome was to evaluate differences between the psoas cross‐sectional area and f(PMI) between the groups, if any. Results Both groups were comparable in terms of demographic characteristics. Psoas cross‐sectional area (extubation success group, 1,776.5 ± 498.2 mm2, extubation failure group, 1,391.2 ± 589.4 mm2; P = 0.022) and PMI (extubation success group, 1,089 ± 270.7 mm2/m2, extubation failure group, 889 ± 338.5 mm2/m2; P = 0.032) were significantly greater in the extubation success group than in the extubation failure group. Conclusions The psoas cross‐sectional area and PMI can predict extubation outcomes in elderly intensive care patients.
Collapse
Affiliation(s)
- Fumimasa Kobori
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Kazunari Azuma
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Shiro Mishima
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Jun Oda
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| |
Collapse
|
48
|
Oda J, Takashi M, Matsuyama S, Tanabe S, Nishimura T, Sugawara Y, Ogura S. JAAM Nationwide Survey on the response to the first wave of COVID-19 in Japan Part II: How the medical institutions overcame the first wave and how to prepare in future? Acute Med Surg 2020; 7:e592. [PMID: 33230419 PMCID: PMC7675700 DOI: 10.1002/ams2.592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 09/26/2020] [Accepted: 10/05/2020] [Indexed: 12/23/2022] Open
Abstract
Aim To investigate and clarify the surge capacity of staff/equipment/space, and patient outcome in the first wave of COVID-19 in Japan. Methods We analyzed questionnaire data from the end of May 2020 from 180 hospitals (total of 102,578 beds) with acute medical centers. Results A total of 4,938 hospitalized patients with COVID-19 were confirmed. Of 1,100 severe COVID-19 inpatients, 112 remained hospitalized and 138 died. There were 4,852 patients presumed to be severe COVID-19 patients who were confirmed later to be not infected. Twenty-seven hospitals (15% of 180 hospitals) converted their ICU to a unit for COVID-19 patients only, and 107 (59%) had to manage both severe COVID-19 patients and others in the same ICU. Restriction of ICU admission was occurred in one of the former 27 hospitals and 21 of later 107 hospitals. Shortage of N95 masks was the most serious concern regarding personal protective equipment (PPE). As for issues which raised ICU bed occupancy, difficulty performing or progressing rehabilitation for severe patients (42%), and the improved patients (28%), long lasting severely ill patients (36%) and unclear isolation criteria (34%) were mentioned. Many acute medicine physicians assisted regional governmental agencies functioning as advisors and volunteer coordinator. Conclusion The mortality rate of COVID-19 in this study was 4.5% of all hospitalized patients and 14% (approximately one in 7) severe patients. The hospitals with dedicated COVID-19 ICUs accepted more patients with severe COVID-19 and had lower ICU admission restrictions, which may be helpful as a strategy in the next pandemic.
Collapse
Affiliation(s)
- Jun Oda
- Labor management committee Japanese Association for Acute Medicine (JAAM) Japan.,Department of Emergency and Critical Care Medicine Tokyo Medical University Japan
| | - Muguruma Takashi
- Labor management committee Japanese Association for Acute Medicine (JAAM) Japan.,Advanced Critical Care and Emergency Center Yokohama City University Medical Center Yokohama Japan
| | - Shigenari Matsuyama
- Labor management committee Japanese Association for Acute Medicine (JAAM) Japan.,Department of Emergency and Critical Care Medicine Hyogo Emergency Medical Center Japan
| | - Seizan Tanabe
- Labor management committee Japanese Association for Acute Medicine (JAAM) Japan.,Foundation for Ambulance Service Development Emergency Life-Saving Technique Academy of Tokyo Japan
| | - Tetsuro Nishimura
- Labor management committee Japanese Association for Acute Medicine (JAAM) Japan.,Department of Traumatology and Critical Care Medicine Graduate School of Medicine Osaka City University Japan
| | - Yoko Sugawara
- Labor management committee Japanese Association for Acute Medicine (JAAM) Japan.,Department of Emergency and Critical Care Medicine Tokyo Saiseikai Central Hospital
| | - Shinji Ogura
- Labor management committee Japanese Association for Acute Medicine (JAAM) Japan.,Department of Emergency and Disaster Medicine Gifu University Graduate School of Medicine Japan
| |
Collapse
|
49
|
Aida K, Azuma K, Ishii Y, Suzuki S, Oda J. Saving patients with out-of-hospital cardiac arrest using Impella: three case reports. Acute Med Surg 2020; 7:e564. [PMID: 32995019 PMCID: PMC7507025 DOI: 10.1002/ams2.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/15/2020] [Accepted: 08/03/2020] [Indexed: 11/29/2022] Open
Abstract
Background The efficacy of Impella for patients with out‐of‐hospital cardiac arrest is unknown. We report the cases of three patients with cardiogenic out‐of‐hospital cardiac arrest who received hemodynamic support with Impella. Case presentation Two patients, Case 2 and Case 3, received concomitant treatment with venoarterial extracorporeal membrane oxygenation and Impella. Percutaneous coronary intervention was undertaken in two patients, Case 1 and Case 3. Two patients, Case 1 and Case 3, showed favorable neurological function with the Glasgow–Pittsburgh cerebral performance and overall performance categories score of 1 at discharge. Conclusion These findings suggest that Impella is effective in patients with out‐of‐hospital cardiac arrest. Further studies are required to understand the use of Impella for patients with out‐of‐hospital cardiac arrest.
Collapse
Affiliation(s)
- Kenta Aida
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Kazunari Azuma
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Yuri Ishii
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Shoji Suzuki
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Jun Oda
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| |
Collapse
|
50
|
Minami Y, Mishima S, Oda J. Prediction of the level of consciousness using pupillometer measurements in patients with impaired consciousness brought to the emergency and critical care center. Acute Med Surg 2020; 7:e537. [PMID: 32685175 PMCID: PMC7358821 DOI: 10.1002/ams2.537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 11/13/2022] Open
Abstract
Aim We investigated whether the level of consciousness can be predicted using pupillometer measurements in patients with severe disturbance of consciousness. Methods Patients with a Glasgow Coma Scale (GCS) of 3–8, except for those after cardiac arrest, were included. Pupillary contraction rate and contraction velocity were each measured using a pupillometer. Results Thirty‐five patients were analyzed. At the time of discharge or changing hospitals, 16 patients had a GCS score of 3–13 and 19 patients had a GCS score of 14–15. In the non‐sedative group at about the time of arrival at our hospital, average pupillary contraction rates were 18.36% in the GCS 3–13 group and 19.67% in the GCS 14–15 group (P = 0.739), and average pupillary contraction velocities were 1.02 and 1.48, respectively (P = 0.182). Approximately 48 h after arrival, average pupillary contraction rates were 21.18% and 29.27%, respectively (P = 0.058), and average pupillary contraction velocities were 1.37 and 1.91, respectively (P = 0.172). Among the sedative group, at about the time of arrival, average pupillary contraction rates were 8.75% in the GCS 3–13 group and 19.75% in the GCS 14–15 group (P = 0.032). Average pupillary contraction velocities were 0.34 and 1.48, respectively (P = 0.001). Approximately 48 h after arrival, average pupillary contraction rates were 13.50% and 13.50%, respectively (P = 1.00), and average pupillary contraction velocities were 0.80 and 0.82, respectively (P = 0.93). Conclusions Pupillometer measurements could predict level of consciousness of patients with severe consciousness disorder.
Collapse
Affiliation(s)
- Yosuke Minami
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Shiro Mishima
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Jun Oda
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| |
Collapse
|